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Pregnancy in the Time of COVID-19

With the world being confronted with another corona virus, many pregnant patients are eager to learn about any virus-related risks during pregnancy.

Thomas Van Geem, MD—a board-certified OB/GYN since 1989 who has performed more than 20,000 obstetrical and gynecologic cases—offers the following facts to help educate women who are pregnant during these unprecedented times.

The corona virus disease—known as SARS, coV-2—was named because its sequence is markedly similar to a worldwide outbreak of SARS in 2002 to 2003.

Signs & Symptoms

The signs and symptoms of COVID-19 are similar in pregnant patients relative to the general population at large. Fever occurs in approximately 84%, cough between 59% to 82%, fatigue 44% to 70%, anorexia 40% to 84%, shortness of breath 31% to 40%, sputum production 28% to 33% and muscle aches up to 35%. Many patients are asymptomatic or pre-symptomatic. Laboratory findings with this disorder include lymphopenia, which implies the low lymphocyte count; prolonged PT, which is a prolongation of clotting time; and elevated lactate dehydrogenase (LDH). CT scans of the chest will reveal patchy shadow changes or ground glass opacities.

COVID-19 & Pregnancy

The risk of COVID transmission in utero from mother to baby appears to be very low. An analysis in the American Journal of OB/GYN in May 2020 reviewed 12 articles involving 68 deliveries and 71 neonates, in which 4 out of 71 neonates developed neonatal infection 48 hours after birth. Another med analysis reviewed 18 studies and found no evidence of direct vertical transmission. Overall, vaginal delivery of a COVID-positive pregnant patient, infectious or noninfectious, appears to be a very safe and reasonable method. This finding was reinforced in a Northern Italian study involving 12 hospitals and 42 deliveries. If vertical transmission does occur, it would be considered a rare event. Another study from China evaluated amniotic fluid in the second trimester. No detection of the virus was seen by PCR, which is considered one of the most accurate laboratory methods for detecting, tracking and studying the corona virus.

Infants Born to Patients with COVID

Pregnant patients who do have the active virus or a positive antigen test undergo isolation. Aggressive therapy may be required for oxygen therapy to avoid fluid overload; antibiotics are given if secondary infection to the suspected, mechanical ventilation support in ICU is used. Almost all patients now need to be considered for DVT prophylaxis with either heparin or Lovenox. Evaluation of heart function will be part of the routine care. Personal protective equipment for all health care providers will also be included. Negative pressure rooms will be required in labor and delivery. Infants born to patients with COVID positive should be considered positive and immediately isolated from the mother. Breastfeeding will be encouraged through a pump system. The newborns will be tested frequently during the postpartum period.

For more information, call 805.495.4545 or visit http://www.VanGeemMD.com/. Dr. Thomas Van Geem’s office is located at 2220 Lynn Road, Suite 108, in Thousand Oaks.

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