Pregnant Women Especially Vulnerable to COVID-19
By Eunice Ruth
Even though COVID-19 deaths have increased drastically on a daily basis, yet no special attention had been paid to the risk factor it bore on pregnant women, until the recent death of one. Previously, there had been no evidence that pregnant women had an increased risk of severe illness from COVID-19 particularly in the third trimester compared to non-pregnant women.
Now, it is found that pregnant women who are older and have pre-existing medical conditions are considered to be at an increased risk of developing severe illness. When pregnant women develop severe disease, they also seem to more often require special care in intensive care units, than non-pregnant women. Due to the changes in their bodies and immune systems, pregnant women can be badly affected by some respiratory infections. Some research also suggests that pregnant women with COVID-19 are more likely to have a premature birth or caesarean section, and their babies are more likely to be admitted to a neonatal unit.
Just like others, the COVID-19 pandemic is inevitably resulting in an increased amount of anxiety in the general population, and this is likely to be even more for pregnant women and their families as pregnancy presents an additional period of uncertainty. Isolation, financial difficulties, insecurities and inability to access support systems are all widely recognized risk factors which will affect the mental health of a pregnant mother.
Current situation in Sri Lanka
Dr. Sanath Lanerolle, Consultant in Obstetrics and Gynaecology at Castle Street Women’s Hospital said that, in Sri Lanka at present there are more than 310,000 pregnant women and among them, within the period of the last six months almost 1,000 mothers were infected with the virus. Most of them have recovered after getting treatment from the treatment centres, while, the first COVID-19 related pregnancy death was recorded on 4 May.
The COVID-19 variant which is currently spreading within the country is highly dangerous for everyone and especially for pregnant women as it doesn’t show any symptoms in the early stages. A mother who is less than 28 weeks pregnant will not show any kind of COVID-19 symptoms and only a PCR or rapid antigen test could say whether the women has been infected with the virus or not. Women who are in their third trimester or after 28 weeks are very vulnerable to the impacts of the COVID-19 virus. Even though it shows mild symptoms it can lead to serious complications.
“Due to the variant change the risk of virus spreading has increased along with the complications and it is very important that they should attend clinics without avoiding it and even for small pain or physical changes, the mother should reach the doctor immediately to avoid further complications in the delivery. Also, it is important that the pregnant women and their surrounding people should take precautions to protect the mother and others against the COVID-19 spread,” said Dr. Lanerolle.
Meanwhile, Obstetrician & Gynaecologist at the COVID-19 unit at Colombo East Base Hospital, Dr. Mayuramana Dewolage said that, in the first wave, the rate of infection among pregnant women was so low when comparing with this third wave. In April 2020 it was only two patients but now, up to today it has increased up to 903 patients. If relevant precautionary measures are not taken by the Government and authorities, it expected to see a spike in pregnant women infection cases in upcoming days, he said. In addition, most importantly, the rate of conducting C-section deliveries has increased due to the risk factor. Meanwhile, he further said that, currently, Sri Lanka has two separate main hospitals which can be used to isolate and treat pregnant women and the high risk patients will get transferred to the main two hospitals. Even though we don’t have enough facilities, still we managed to provide proper treatments to the patients at the hospital.
“in Sri Lanka, currently, six serious cases have been identified within the country and four are getting treatments at the Colombo East Base Hospital and Base Hospital Homagama, while, one deceased and another serious pregnant women is currently receiving ‘Ecmo treatment’ at Karapitiya hospital,” said Dr. Dewolage.
Women should be advised that vaccination against the virus is safe at all gestations of pregnancy and is recommended to protect both the mother and the baby from the adverse effects of becoming seriously ill with the virus during pregnancy. It's preferable to have the Pfizer-BioNTech, because it has been more widely used during pregnancy in other countries and has not caused any safety issues.
Mainly, the vaccination should be given in two main situations where if the pregnant woman faces breathing difficulties or in sudden cases where the women get infected with the virus.
As suggested, like all other front line workers, pregnant women in the country should get vaccinated in order to protect them.
What pregnant women can do?
Dr. Achintha Dissanayake the registrar in Obstetrics and Gynaecology said that, pregnant women who are above 35 years old are a special group who needs to be very careful with the virus spread. Most importantly, last weeks of pregnancy and delivery can be complicated due to the complications which could arise due to the virus spread within their body. To reduce the risk of infection they should avoid close contact with anyone who is sick or has symptoms and others beyond the household. Pregnant women should take necessary precautions such as wearing a facemask, sanitizing hands, maintaining social distancing (two metres) and most importantly they should avoid moving in crowded locations as much as possible
Further, mask guidance differs depending on whether you are fully vaccinated or unvaccinated. It was also suggested that double masking can reduce the risk of contracting of spread. Also, washing hands often with soap and water for at least 20 seconds, or using an alcohol based hand sanitizer that contains at least 60 percent alcohol, can reduce the risk of virus contraction.
Dr. Pradeep de Silva, President of the Sri Lanka College of Obstetricians and Gynaecologists noted that about 80 percent of women who develop the disease are asymptomatic and they can be self-isolated at their places with the help of a small medical instrument called Pulse Oximeter which can be used to measure the oxygen level of the blood. Meanwhile, for the remaining 20 percent symptomatic women, they should get treatment at the hospital with proper advice from the senior doctors and other staff as their risk is high when compared with others.
“As a suggestion to minimize the threat-to-life of pregnant women in the society, the government should be ready to face the future threats and complications. In order to reduce the risk rates, the Government should establish Special Care Centres for pregnant women for each District with needed facilities. 50 to 200 beds, High Dependency Units (HDUs) with 10 to 50 high oxygen flow devices, four to ten ICU Beds and two ‘ecmo’ treatment units,” said Dr. Silva.