Despite rapidly evolving knowledge about COVID 19 infection, routes of perinatal COVID 19 transmission and viral load in mother neonate dyad remain uncertain. Data were analysed to describe the clinicodemographic profile and viral load in neonates born to COVID 19 positive mothers. Of 2947 deliveries, 69 mothers were COVID 19 positive (2.3%), with 1 abortion, 2 macerated stillbirths and 2 fresh stillbirths as pregnancy outcomes. Of 65 tested neonates, 10.7% (7) were confirmed COVID 19 positive by RTPCR (reverse transcriptase-polymerase chain reaction). Viral load (cycle threshold, Ct of E, RDRp) in neonates was comparable with the Ct reported from adults; however, neonates had milder clinical manifestations. All 7 neonates who tested positive for COVID 19 were subsequently discharged. Six of the 7 neonates were asymptomatic and 1 neonate needed respiratory support (indication being prematurity) which resolved after 48 h. Maternal and neonatal comparison of Ct of E and RdRp gene was statistically non-significant (25.97 vs 19.68, p = 0.34 and 26.5 vs 25.0, p = 0.84). Viral loads of mothers with COVID 19 positive neonates compared with mothers with COVID 19 negative neonates for E and RdRp gene were also statistically non-significant (25 vs 27.19, p = 0.63 and 19.6 vs 27.6, p = 0.08). The majority (93%) of neonates tested later than 48 h (roomed in with mother and breastfed) tested negative. Conclusion: The study supports milder manifestation in COVID 19 positive neonates. Risk of transmission from COVID 19 positive mother to neonate by rooming-in and breastfeeding is low. In this study on a limited number of neonates, maternal viral load was not found to be associated with the positivity status or severity of the illness of neonate.
Introduction
The COVID19 pandemic raises a major concern about its severity in pregnancy, fetomaternal outcomes and risk of vertical transmission.The Cycle threshold indicating the viral load can be a contributory factor towards modifying the management of such pregnant women. We report a retrospective descriptive study regarding the clinical course, fetomaternal outcomes of pregnant women with COVID19.
Methodology
This is a single-center, retrospective study performed in a tertiary care hospital for pregnant women with COVID-19 in India. The medical records of the all women who delivered in the Covid facility from May 5th 2020 to June 5th 2020 were reviewed independently. Data extracted from the records included demography, obstetric details, co morbidities, disease severity, investigations, management and information on neonates (birthweight, Apgar score, and perinatal complications).Statistical analysis was performed by the SPSS program for Windows, version 17.0(SPSS, Chicago, Illinois)
Results
Amongst 348 women(suspects) tested for SARS-CoV-2, 57 women ( 57/348,16.3%) were confirmed positive based on qRT-PCR of nasopharyngeal specimen. Most women (45 /78.9 %) had mild infection with favourable fetomaternal outcomes. Three maternal mortalities were associated with co morbidities. Five neonates tested positive for SARS-CoV-2, remained haemodynamically stable and were subsequently discharged.
Conclusions
Majority of pregnant women with Covid-19 had mild disease and recovered subsequently with good perinatal outcomes. Women with co morbidities may have increased risk of severe morbidity and mortality.The Cycle threshold signifying the viral load and degree of infectivity can modify the management during pregnancy.Long-term outcomes and the potential mother-to-child vertical/horizontal transmission needs further study.
Labor and delivery-related complications being the largest contributors to India's high maternal mortality rate, optimizing labor and delivery are of utmost importance. This study analyses the safety and efficacy of active management of labor at a secondary hospital using the protocol proposed by Daftary [1].Women in labor with a term pregnancy who consented to the protocol formed the study group. The control group was managed expectantly. The 2 groups of 700 participants each were similar regarding parity, age, and pregnancy-related complications such as pregnancy-induced hypertension, intrauterine growth retardation, and postdatism.A gel preparation containing 0.5 mg of prostaglandin E2 was instilled intracervically in women with a Bishop score of 6 or less, and oxytocin was administered for labor augmentation if necessary. The partogram was then started, and amniotomy performed [2]. At the onset of the active phase of labor, 6 mg of pentazocin (an opioid analgesic) and 2 mg of diazepam (a tranquilizer) were diluted in distilled water and administered intravenously, and 50 mg of camylofin dihydrochloride (a smoothmuscle relaxant) was administered intramuscularly. Three hours later an injection of tramadol hydrochloride (an analgesic) or drotaverine hydrochloride (an antispasmodic) was given, the latter being repeated every 2 h depending on the partogram and the patient's pain score. An injection of 125 mg of carboprost tromethamine was given intramuscularly after delivery to promote contraction and retraction of the uterine musculature. The remainder of the pentazocine and diazepam mixture was injected while the episiotomy was being sutured. The pain score was tabulated, and the total duration of labor and labor outcomes were analyzed. P b.05 was considered significant in determining the effect of active management of labor on the rate of cesarean deliveries. An attempt was made to identify the indications that could benefit from this protocol.
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