Relevant advice for health care-givers, mothers-to-be

(Mains GS 2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.)

Context:

• India’s demographic dividend is largely dependent on its high birth rate. 
• The number of births in India is around 72,000 per day and by taking into account the 10 month duration of gestation and pregnancy losses, the number of pregnant women on any single day will be much larger. 
•  Maternity services in India, both public and private, already overburdened with large numbers even in pre-COVID-19 times, face a crisis situation with the conditions caused by the pandemic.

A danger:

• Recent reports on pregnant mothers have uncovered many serious medical problems faced by pregnant women who contract COVID-19.
•  The  new-born  faces pre-eclampsia, pre-term labour maternal infections, increased caesarean section rates, fetal growth restriction due to placental insufficiency, still births, neonatal infections and respiratory distress. 
• According to a recent publication in the Journal of the American Medical Association, maternal mortality is several-fold higher in COVID-19 positive pregnant mothers than in non-COVID-19 pregnant women. 

Complication increased:

• Many pregnant women need admission to the intensive care unit and prolonged hospitalisation. Of all the COVID-19 deaths in the paediatric age-group, neonatal deaths are the most common.
• All maternal and neonatal complications increase with maternal obesity and diabetes in pregnancy — problems that are common in pregnant women in India. 
• These facts underscore the need for urgent action to minimise the impact of the coronavirus infection on pregnant mothers and new-born.

Urgent need of actions:

• There is an urgent need for action from professional bodies to avert a serious calamity.
•  The Government, in consultation with these bodies, should immediately facilitate counselling and care for women in the reproductive age group and provide resources to health-care professionals involved in their care.
•  The potential adverse effects of COVID-19 in pregnancy can be averted by pre-conceptional advice for women planning a pregnancy during COVID-19 times.

Steps to be taken:

• The massive increase in numbers of COVID-19 infections with the second wave affects pregnant mothers.
•  This important matter should be taken up on a war footing, alerting women in the reproductive age group and the medical profession.
• Two important steps must be considered immediately: Advise all women to postpone pregnancy till both partners are vaccinated; Offer vaccination to all un-vaccinated pregnant women.

Postpone pregnancies:

• They can be redTemporary and reversible contraception during COVID-19 times is a simple and effective way to postpone pregnancies.
• Postponed pregnancies decrease the number of women who would otherwise seek antenatal advice in crowded hospitals and risk exposure to infection. 
• The demands on health-care personnel who provide antenatal care would also decreases
• Health care personnel can be redeployed for COVID-19 care and the vaccination programme.

Procedure to be followed:

• Reduction in the number of antenatal visits, online consultations, protocols for ultrasonography, glucose tolerance test and antepartum fetal evaluation have to be followed by care givers.
• Ultrasound scans are routinely done during pregnancy.
•  Dedicated and safe ultrasound scan centres for pregnant women, manned exclusively by immunised personnel (either vaccinated or after recovery from previous COVID-19 infection) is a need of the hour.
• Pregnant women with fever should be considered to have COVID-19 unless proven otherwise and be taken care of in triage areas with all personal protective measures in place till COVID-19 test results are available.

Segregation required:

• At present, COVID-19 and non-COVID-19 pregnant women coming for delivery are not strictly segregated in many hospitals.
•  It is high time that COVID-19 pregnancies and non-COVID-19 pregnancies are handled in different settings to prevent infecting susceptible mothers.
•  Both types of facilities should be manned by immunised personnel, the first to prevent infections in health-care personnel and the second to prevent infections in susceptible mothers.
• Unvaccinated health-care workers providing care for pregnant women should be quickly vaccinated.

Clear benefits of vaccination:

• The health authorities in the United Kingdom and the United States have realised the benefits and the safety of vaccinating pregnant women and have approved vaccination of all pregnant women with mRNA vaccines.
• These COVID-19 vaccines have been found to produce a good immune response and, maternal antibodies, demonstrated to cross the placenta and enter the fetus, confer protection against maternal to fetal transmission of the virus. 
• The benefits of vaccination far outweigh the risks.

Inactivated virus vaccine is more safe:

• Pregnancy and the immediate postpartum period are pro-thrombotic states which favour the formation of blood clots in veins
• The vectored vaccine (Covishield) was found to be associated with rare but serious side-effects pertaining to thrombosis of the veins draining critical areas such as the brain and intra-abdominal organs.
• However this side-effect may be a feature of all vectored vaccines against COVID-19. 
• In general, inactivated virus vaccines are safe during pregnancy and the World Health Organization has given a nod to the use of the inactivated Synovac vaccine. 
• Therefore, the inactivated vaccine available in India (Covaxin) may have advantages over the vectored vaccines (Covishield and Sputnik) for vaccinating pregnant women.

Promote awareness:

• The availability and advantages of the vaccine for pregnant women should be publicised and awareness should be created among the public.
•  Vaccine hesitancy in pregnant women is likely to be much higher than in the general population and this should be addressed by information, education and effective communication.
•  Professional bodies recommended to the Ministry of Health and Family Welfare that vaccination be offered to pregnant women after providing adequate information and counselling.

Conclusion:

• India will do well to enhance vaccination coverage of couples planning pregnancy and pregnant women on a priority basis in order to protect mothers and their new-born.