COVID-19 and Pregnancy: What Reproductive Medicine Professionals Should Do?

As of now, one can only take cues from SARS-CoV and MERS-CoV that was associated with spontaneous miscarriage, intrauterine growth restriction (IUGR), preterm delivery, and other adverseobstetrical outcomes.

COVID-19 (Coronavirus Disease 2019) poses an unprecedented challenge to the world. Caused by the novel coronavirus SARS-CoV-2, the viral pandemic will affect millions globally, baring open our frailing healthcare infrastructure and lack of preparedness. As the situation is still evolving and the knowledge base continues to grow, not much is objectively known about COVID-19, its nature, and its other clinical aspects. A key concern, among several, for the reproductive medicine professionals, is if the vertical transmission is possible – if a woman is tested positive for COVID-19, can the virus be transmitted during the pregnancy.

 

Can We Learn From The Past?

 

Looking back at SARS and MERS, there hasn’t been any documented evidence of maternal-fetal transmission. Experts do, however, believe that the number of cases investigated is less and insufficient to make any conclusive remark. Similarly, with SARS-CoV-2, not a lot is known. The reported number of cases of pregnant women tested positive for the disease is few and far between; further, lack of follow-up on them makes it even more challenging to understand how coronavirus affects pregnancy.

Answering if COVID-19 can cause problems during pregnancy, the Centers for Disease Control and Prevention (CDC) says, “We do not know at this time if COVID-19 would cause problems during pregnancy or affect the health of the baby after birth.”

In such a scenario when there’s a lack of substantial data, the professionals in reproductive medicine must follow the basic protocols so as to avoid any adverse maternal and neonatal outcomes. At the same time, they must adhere to the guidelines outlined by the health officials, including social distancing and enhancing personal hygiene. Also, during such an outbreak when the number of fatalities is expected to go high, resource optimization and preservation are also of utmost importance for the reproductive medicine professionals.

 

Recommendations to Follow

 

The ultimate goal for any healthcare professional isn’t just to deliver on the needs of the patients but also to mitigate risks for themselves, their associates, staff members, and the community at large. So, along with proper treatment, strict prevention and control measures should essentially be in place. That said, here are some of the recommendations for reproductive medicine professionals and staffs:

Minimize risks by following basic measures. Like, maintain social distancing, accommodate patients into the clinical spaces after assessing their health status, lower the number of people in the clinic, create an infrastructure for telehealth, encourage staff members to work from home whenever possible, and maintain adequate availability of Personal Protective Equipment (PPE).

Advise the patients to not travel to the clinic in non-urgent cases but instead, first, consult over the phone. A lot of the cases can be dealt with over telehealth.

Suspend the start of new treatment cycles, like IVF, IUIs and ovulation induction. After the completion of a single cycle, postpone further treatment. Advise patients against elective surgeries and non-urgent interventional diagnostic procedures; postpone them.

Continue the treatment in urgent cases and of the patients who have already started the oral medications. Take all the precautionary measures; follow the guidelines by WHO.

Take adequate steps to ensure maximum hygiene and care of the laboratories. Interactions between laboratory staff and patients should be minimal. While the initiation of fertility treatment of patients with active SARS-CoV-2 is advised against, if it still must go, the specimen or sample collected must be handled with special care.

These are difficult times that could be overwhelming for the patients, as well as the reproductive medicine professionals and medical staff members. Seeking help from mental health professionals should be a viable option. If the staff members, doctors, and patients are showing signs of emotional strains, a mental health professional should be approached. Of course, keeping in view the guidelines, the counseling sessions are best done over the phone or webcam instead of an in-person visit.

The uncertainty of COVID-19, and the anxiety around it, is still very high. It’s a challenging time for healthcare professionals – and the communities at large – to be in. As we register and examine more cases, the picture will get clearer as to how SARS-CoV-2 affects pregnancy. But, as of now, we can only follow the basic guidance, preventive measures, common sense, and the commitment to deliver the best treatment – with the intent to mitigate risks for the patients, doctors, nurses, clinical staff, and the collective society.

(Sources, Sources, Sources)

 

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Dr. Pradip Goswami

Dr Pradip Goswami graduated from NRS Medical College, Calcutta in the year 1991. After finishing his Diploma in Obstetrics and Gynaecology from R G KAR Medical College, he relocated to United Kingdom in 1997. Having achieved MRCOG in 2001 and completing his training in General Obstetrics & Gynaecology, he had undergone Structured Special Skills Training in Maternal and Fetal Medicine for management of complicated pregnancies under Royal College of Obstetricians and Gynaecologists of London.

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