What you need to know:
- Covid-19 does not affect the baby in the uterus but pregnant women who get severe disease are likely to have preterm births writes Beatrice Nakibuuka
Patience Atuhaire observed all the SOPs because she did not want to contract Coronavirus given her vulnerability as an expectant mother. She was always masked up to the extent that she almost went to bed covered.
At work place she tried to minimise direct contact with other people.
But she still caught Covid-19.
“It all started with a dry cough and flu when I was eight months pregnant,” Atuhaire, whose baby is now five months says.
“At first I did not take it seriously until I developed chest pain two days later. I became so scared since more people were dying of the disease.”
At Mulago Hospital, where she was accompanied by her husband, she tested positive for Covid-19 and her doctor advised her to start treatment right away but discouraged her from herbs and steaming because she was pregnant.
“At first the treatment did not seem effective. I developed difficulty in breathing and I was immediately taken to the Intensive Care Unit. The gynaecologist argued there was a risk of losing the baby,” she says.
Fortunately, the baby had a few weeks left to go so it was delivered by C-section and taken to the nursery.
“I got better after about three weeks of treatment but spent another in hospital being monitored as I waited for my baby to gain the necessary weight. We later got discharged after the doctors assessing that I was ready to be on home based care while I nurse my baby,” she says.
Atuhaire, even after giving birth, ensured that she observed the SOPs like hand washing and wearing a mask whenever she was holding her baby.
“I am glad I did not infect my baby,” she says.
Atuhaire is one of the many expectant mothers who were treated and recovered completely.
The severity of Covid-19
Dr Junior Ndozire, a gynaecologist at Mildmay Hospital says, compared to non-pregnant women, a pregnant woman in the second and third trimester is likely to get severe disease of the Coronavirus.
Pregnant women with symptomatic Covid-19 requiring admission to hospital have worse maternal outcomes, including death, although the absolute risk remains very low.
“Pregnant women and neonates are often categorised as being at high risk. However, pregnant women with Covid-19 in the third trimester are more likely than their non-pregnant counterparts to require intensive care,” he says.
According to Othman Kakire, a gynaecologist at Kawempe National Referral Hospital mothers who are slightly overweight and those with pre-existing medical disease conditions such as diabetes, high blood pressure and others are more susceptible to severe disease.
“Outcomes of neonates born to women positive for Covid-19 are generally very good, though the risk of prematurity as well as Caesarean delivery is increased. Pregnant mothers with Covid-19 are also more prone to having complications such as deep venous thrombosis (DVT), stroke and pre-eclampsia,” he says.
How safe is the baby?
Depending on the severity of the disease, a mother can hold the baby up to term if she is asymptomatic (where the mother is positive for the disease but shows no signs and symptoms) or has mild symptoms such as mild flu and headache which may allow the progression of the foetus because it is easy to treat and control, says Dr Sabrina Kitaka, a paediatric infectious disease specialist.
However, in severe cases where there is difficulty in breathing and severe chest pain, the mother can have an intra uterine death of the foetus, premature delivery, still birth or even a miscarriage.
Dr Kakire also warns that if the disease is very severe, the doctor may choose to take such a mother into theatre for immediate delivery irrespective of the stage of the baby especially if the mother is at risk of dying.
There is no conclusive evidence that Covid-19 crosses the placenta and infects the foetus, says Dr Joseph Ngonzi, a senior lecturer, Obstetrics and gynaecology, Mbarara University of Science and Technology.
“The safety of the baby is not guaranteed since few studies have been carried out in this regard. Reports of Covid-19 infection in the neonate have generally described mild disease. Apart from the risk of the unborn baby being born premature, there have been no documented congenital abnormalities/defects,” he says.
Management of pregnant mothers
Management of Covid-19 pregnant mothers is multi-disciplinary and depends on the severity of the disease. However, the pregnant mother requires at least an obstetric follow up every fortnight.
After delivery, Dr Ngonzi says, “mothers are required to breastfeed their babies normally but take precautions to prevent infecting the baby by observing standard operating procedures (SOPs) such as hand and breast hygiene and using a face mask to prevent transmission.”
Drug regimens that have been used in the management of Covid-19 have all been encouraged to be used in pregnant women according to the different studies and guidelines as being safe.
Dr Kakire says, “There are no medicines that would be left out in the treatment of an expectant mother with the Coronavirus. We weigh between saving the mother and keeping the child and since she cannot be replaced easily, we save the life of the mother first.”
Is vaccination recommended?
Although pregnant mothers were excluded from being vaccinated because the vaccine has not been tested on pregnant women, Centre for Disease Control (CDC) recommends that they get vaccinated because the vaccine goes directly to the placenta and protects the unborn baby.
Dr Kitaka, advises that a pregnant woman should not go for a second jab and must contact a gynaecologist if they develop serious side effects after getting the first jab and that if possible, a woman should get her vaccine before she conceives.
Dr Ngonzi says, “It is now considered safe for pregnant women to receive Covid-19 vaccines. It should be noted however that a minimum interval of 14 days should be allowed between routinely administered vaccines during pregnancy and Covid-19 vaccines.”
HOME BASED CARE
Home based care for pregnant women with COVID -19
When a pregnant woman gets Covid-19, it is paramount that they do not self-medicate. Instead, Dr Ndozire recommends that a pregnant woman should visit a health facility where severity of disease will be assessed and appropriate medication prescribed.
After assessment by qualified personnel, home treatments should always be guided by a qualified health worker.
“It is important to avoid steaming when pregnant, as well as other prescribed herbal medicines and conventional medicines,”Dr Ndozire says.
Only pregnant women with asymptomatic or mild cases of Coronavirus should be on home based care for the treatment of the disease. However, it is important to note that there is no documented evidence on the use of concoctions and steaming remedies in treatment of Covid-19 pregnant mothers.
Home based care for Covid-19 pregnant women entails, but not limited to the following: 14 days self-quarantine, adequate hydration, adequate rest, frequent ambulation as tolerated, zinc sulphate, vitamin D and C.