RCOG World Congress 2023

Which is the ideal treatment for Covid 19 Positive Pregnant Women ?

(An observational study in a Dedicated COVID 19 Hospital in Central India)

Prof Dr Anupama Dave

MS MRCOG FACOG DNB

Professor and Unit Head

MGM Medical College, Indore, India

Introduction

•2019 - COVID-19-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) - a global public health emergency

•Covid19 infection upsurged as a havoc for humans as a whole ,pregnant women were affected too

• In Past 2 decades -2 notable β-coronaviruses - SARS-CoV & MERS-CoV

•COVID-19 belongs to the same β-coronavirus subgroup - Shares genome similarity

•Pregnancy and Covid 19 was a different scenario altogether

•With different variants of the virus constantly emerging

•Information is constantly evolving rapidly, Guidance by organizations regularly being updated and modified

•The main dilemma was the treatment protocol in pregnancy

•First wave of pandemic –asymptomatic and mild disease was seen , early termination of pregnancy was not indicated

•Second wave more of severe and critically affected cases – and more of maternal deaths in cases in whom inspite of morbid condition continuation of pregnancy was being considered

•But for the benefit of mother and to improve respiratory function we thought of termination as an option, specially after inputs of the multidisciplinary covid management team

Aims and Objectives

•To study the outcome of various treatment modalities on COVID 19 positive pregnant women

•To propose a suitable treatment protocol

•To study the outcome of women who were delivered for maternal benefit

Methodology

•A prospective observational study was done in MTH Dedicated Covid Hospital in Indore MP from 17 April 2020 to 31 May 2021 .

•The clinical outcome of 249 pregnant women admitted during the first & second waves of the COVID 19 pandemic were analysed in reference to the treatment given as per national and international guidelines .

• As per institutional protocol induction of labor for termination of pregnancy was done in very severe illness, Remdesavir & IVIG were given on compassionate grounds

Observations

TOTAL 249

• Mild disease 109

• Moderate illness - 76

•Severe illness - 41

•Critically ill - 23

•Conservative management -29

•88 were given Remedasivir

•18 both Remedasivir and IVIG.

•221 mothers were discharged well.

•TOP Obstetric reasons - 93

•TOP Non obstetric reason (maternal benefit ) - 52

• 28 maternal deaths.

All newborns were tested for covid immediately after delivery and were negative.

Conclusions

•Less mortality and higher recovery rate in those who given newer modalities of treatment and had early termination of pregnancy for severe illness

•Thereby emphasizing their use in future such infections

•Each case is different in its way and this is the reason why an individualized approach needs to be adopted for optimizing maternal & fetal wellbeing

•Its importance needs to be emphasized inspite of strict guidelines

•This is possible only with multidisciplinary team involvement.

Recommendations

An Individualized approach would help in optimizing maternal and fetal wellbeing. The world strives to gather more and more data so that more could be known about the virus and better maternal and fetal outcome could be ensured

References

World Health Organization. Rolling updates on coronavirus disease (COVID-19). 2020. Available from: https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/events-as-they-happen.

World Health Organization. Naming the coronavirus disease (COVID- 19) and the virus that causes it. 2020. Available from: https:// www.who.int/emergencies/diseases/novel-coronavirus-2019/ technical-guidance/naming- the-coronavirus-disease-(covid-2019)- and-the-virus-that-causes-it.

Cabinet Office. Guidance. Staying alert and safe (social distancing). Coronavirus (COVID-19) guidance and support. 2020. Available from: https://www.gov.uk/government/publications/staying-alert-and- safe-social-distancing/staying-alert-and-safe-social-distancing [Accessed May 24, 2020].

RCOG. (COVID-19) infection in pregnancy. Available from: https:// www.rcog.org.uk/en/guidelines-research-services/guidelines/ coronavirus-pregnancy/.

Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395(10226):809–815. DOI: 10.1016/S0140-6736(20)30360-3.

Aylward B, Liang W, Dong X, et al. Report of the WHO China joint mission on coronavirus disease2019 (COVID-19) [Internet]. Beijing: World Health Organisation; 2020.

Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS- CoV-2 infection in UK: national population based cohort study. BMJ2020;369:m2107 Available from: https://doi.org/10.1136/bmj.m2107.

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RCOG World Congress 2023

What is the ideal treatment for Covid19 positive pregnant women?

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