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COVID-19 suspicion and diagnosis in pregnancy: A big conundrum!
Parul Singh1, Vandana Bhuriya1, Smiti Nanda1
1Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Insights
Diagnosing coronavirus disease 2019 (COVID-19) in pregnancy is challenging due to physiological changes and asymptomatic cases. Universal testing and streamlined care teams are vital for managing pregnant patients with COVID-19.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Public Health
Background:
- Pregnancy involves physiological changes affecting the cardiorespiratory and immune systems, increasing susceptibility to infections like COVID-19.
- Asymptomatic COVID-19 infections are common in pregnant individuals, complicating early diagnosis and management.
- Comorbidities common in pregnancy, such as preeclampsia and anemia, can further influence COVID-19 presentation and diagnosis.
Purpose of the Study:
- To discuss challenges in diagnosing and managing COVID-19 in pregnant patients.
- To explore strategies for preventing COVID-19 transmission among healthcare workers and the general population.
- To analyze the characteristics of suspected and confirmed COVID-19 cases in a tertiary care labor room setting.
Main Methods:
- A retrospective study analyzing case records of pregnant patients admitted to a tertiary care labor room in India.
- Patients were categorized into suspected and confirmed COVID-19 groups.
- Data on symptoms, comorbidities, and intensive care unit admissions were collected and analyzed.
Main Results:
- Out of 5164 admissions, 95 were suspected COVID-19 cases (1.8%), with only two confirmed positive.
- 84% of confirmed COVID-19 cases in pregnancy were asymptomatic.
- Fever was the most common symptom; preeclampsia and anemia were frequent comorbidities. 32% of suspected cases required ICU admission, often due to respiratory distress.
Conclusions:
- COVID-19 diagnosis in pregnancy is complicated by asymptomatic presentation and physiological changes.
- Relying solely on contact or travel history for COVID-19 suspicion burdens the healthcare system; universal testing is recommended.
- Efficient management requires self-sufficient medical teams to handle suspected, confirmed COVID-19, and routine labor room admissions.
Introduction:
This article aims to discuss all the challenges faced in the diagnosis of coronavirus disease 2019 (COVID-19) in pregnancy, isolation of suspected and positive patients, their management, and the strategies to prevent the transmission of infection among the healthy population and medical fraternity. The diagnosis of COVID in pregnancy is influenced by many factors, including normal physiological changes in pregnancy, comorbid conditions associated with pregnancy, and the presence of asymptomatic infection in patients. Suspicion of COVID-19 in pregnant females is of utmost importance at a primary health center for risk mitigation of exposure to medical personnel.
Material And Methods:
A retrospective study was carried out in the labour room in a tertiary care center in India. Two groups were made, suspected COVID and confirmed COVID in pregnant patients. The case records were analysed.
Results:
Out of a total of 5164 admissions, 95 patients were admitted as suspected (1.8%), but only two patients were COVID-positive amongst them. 84% of COVID-positive patients were asymptomatic. Fever was the most common symptom in both groups (P-value: 0.15). Preeclampsia and anaemia were the most common comorbidities in both groups, not statistically significant. There were 32% of intensive acre unit (ICU) admissions in suspected COVID patients, and 77% of them were having respiratory distress.
Conclusion:
COVID-19 presents as an asymptomatic infection in most pregnant patients. Physiological changes to the cardiorespiratory and immune systems along with associated comorbidities in pregnancy, increase a woman's susceptibility and delay diagnosis. Consideration of patients as suspected COVID at triage stations on the basis of only contact or travel history poses a great burden on the health care system. Although triage is an essential tool to identify symptomatic COVID patients, universal testing strategies should continue simultaneously. Streamlining medical care professionals into self-sufficient teams ensures adequate clinical coverage amongst the suspected COVID, confirmed COVID, and routine labour room admissions.
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