Pregnancy and COVID-19: - Pregnancy does not increase the risk of contracting COVID-19 but can cause more severe symptoms due to an altered immune system. - Most cases in pregnant women are mild, but a small portion can experience severe disease requiring intensive care. - Vertical transmission from mother to fetus/newborn appears rare based on limited data, though a few possible cases have been reported. - Routine antenatal care should focus on telehealth and limiting in-person visits when possible to reduce infection risk. Testing criteria include symptoms or exposure risk. - Management of COVID-19 in pregnancy focuses on supportive care, with delivery timing based on gestational age and maternal condition.

1. COVID19 AND
PREGNANCY
Dr. Shivani Sachdev Gour
M.D. DNB, M.R.C.O.G. (UK)
Dr. Nupur Garg
M.S. (Obs Gyn) F.R.M

2. KEYPOINTS
◉ Introduction
◉ Virology and Epidemiology Clinical Manifestation
◉ Prevention
◉ Course in pregnancy
◉ Approach to diagnosis
◉ Prenatal care
◉ Management of Labour and Delivery PP care
◉ Abortion/ MTP/ Ectopic Pregnancy
◉ HCW Prophylaxis
2

3. Introduction
◉ Coronaviruses are family of enveloped, single-stranded RNA viruses mainly
cause mild symptoms like common cold
◉ At the end of 2019, a novel coronavirus was identified in a worker in Wuhan Sea
food market in the Hubei Province of China who had pneumonia.
◉ It was observed that this strain exhibited stronger virulence and quickly passed
from human to human
◉ In Jan 2020, the WHO designated the disease as public health emergency
◉ It designated this virus as 2019 Novel Corona virus – later it was renamed as
severe acute respiratory syndrome coronavirus 2
◉ (SARS-CoV-2); previously, it was referred to as 2019-nCoV.
3

4. Corona Virus- Notorious past History
2 epidemics in the past belong to β corona virus .Mild illness belonged to α,γ,ς
◉ 2002: Severe acute respiratory syndrome Coronavirus (SARS-CoV)
◉ 2012: Middle East respiratory syndrome Coronavirus (MERS-CoV)
◉ 2019: named SARS-CoV 2 as on genome sequencing shared 79.5% identity to
SARS-CoV. use angiotensin-converting enzyme 2 (ACE2), the same receptor as
SARS-CoV , to infect humans (ZhouP Nature 2020)
◉ Designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
◉ Earlier referred to as 2019-nCoV.
◉ Viral mutations is key for explaining potential disease relapses
◉ In February 2020, the WHO designated the disease COVID-19, which
stands for coronavirus disease 2019 4

5. Marco Cascella:Features
evaluation and treatment
of corona virus 2020
5

6. Routes Of Transmission
6
•Droplets do not linger in air
•Do not travel more than 2 meters
•Also detected in blood and stools
•According to a joint WHO-China report,
fecal-oral transmission did not appear to be
a significant factor in the spread of
infection

7. 2 modes of entry into respiratory epithelium: binding to ACE 2 receptors or direct fusion
Causes cell injury and release of execessive inflammatory cytokines a s apart of normal immune
defence mechanism
.This “Cytokine Storm” or sustained inflammatory response leads to extensive tissue damage,
exudate production and mucus plugging of bronchioles leading to V/Q mismatch and pneumonia
.IL-6 main cytokine causing the storm
7
LUNGS
KIDNEY
GI TRACT
VASCULAR
ENDOTHELIUM
Yan Rong Gua Military Medical Reasearch 2020

8. 8
Marco Cascella:Features evaluation and treatment of
corona virus 2020

9. SYMPTOMS
9
Marco Cascella:Features evaluation and treatment of
corona virus 2020

10. Disease Severity Category
◉ Mild (no or mild pneumonia),
◉ Severe (eg, with dyspnea, hypoxia, or
>50 percent lung involvement on
imaging within 24 to 48 hours)
◉ Critical (eg, with respiratory failure,
shock, or multiorgan dysfunction)
10
Wu Z JAMA 2020, Yang X Lancet Respir
Med 2020

11. 11
Onder G JAMA 2020,Verity R Lancet Infec Dis 2020

12. Risk of Infection in Pregnant
Women
◉ Pregnancy does not increase the risk to contract the infection
than the general population.
◉ But Pregnancy alters the body’s immune system and can cause
more severe symptoms with COVID-19.
◉ This is particularly true towards the end of pregnancy, after 28
weeks .

13. ICMR Guidelines
 Pregnant women do not appear more likely to contract the infection than
the general population. However, pregnancy itself alters the body’s immune
system and response to viral infections in general, which can occasionally
be related to more severe symptoms and this will be the same for COVID-
19.
Reported cases of COVID-19 pneumonia in pregnancy are milder and with good
recovery.
Pregnant women with heart disease are at highest risk (congenital or acquired).
Effect of COVID-19 on Pregnancy

14. ICMR Guidelines
 In other types of coronavirus infection (SARS, MERS), the risks to the mother
appear to increase in particular during the last trimester of pregnancy.
 There are case reports of preterm birth in women with COVID-19 but it is
unclear whether the preterm birth was always iatrogenic, or whether some
were spontaneous.
 The coronavirus epidemic increases the risk of perinatal anxiety and
depression, as well as domestic violence. It is critically important that
support for women and families is strengthened as far as possible; that
women are asked about mental health at every contact
Effect of COVID-19 on Pregnancy

15. ◉ A small study of nine pregnant women in Wuhan, China,
with confirmed COVID-19 found no evidence of the virus
in their breast milk, cord blood or amniotic fluid.

16. Concluded that the subjects didn’t experience more severe
pneumonia than non-pregnant patients

17. ◉ A small retrospective study published in The Lancet
reviewed obstetric and neonatal outcomes of seven
pregnant women at a hospital in Wuhan who had
contracted COVID-19 in their third trimesters. The
outcomes for all seven women were good; none were
admitted into intensive care and all were discharged from
the hospital.

18. Cochrane Database on COVID19 (coronavirus
disease) - Pregnancy
◉ According to WHO, pregnant women
◉ do not appear to be at higher risk of
severe disease.
◉ Furthermore, WHO reports that
currently there is no known difference
between the clinical manifestations of
COVID-19 in pregnant and non-
pregnant women of reproductive age

19. ◉ A (WHO) report concluded that out of 147 pregnant women
diagnosed with COVID-19, : 8% had what the WHO classified as
“severe disease” and 1% were “critical.”
◉ It was determined that they weren’t more likely than non-
pregnant people to develop life-threatening illness

20. ◉ A study of 43 pregnancy women in New York with
confirmed COVID-19 published in the American Journal
of Obstetrics & Gynecology in April found that
unlike SARS and H1N1, pregnant women do not seem to
experience more severe illness from the coronavirus
compared to the general population.

22. ◉ A study published as a letter in The New England Journal
of Medicine looked at testing data from pregnant women
who delivered between March 22 and April 4 at New
York–Presbyterian Allen Hospital and Columbia
University Irving Medical Center in New York City.
◉ Out of 215 patients, 88 percent of the women who tested
positive for COVID-19 did not show any symptoms

23. ACOG is advising caution based on the impact of other respiratory
illnesses (including influenza/ SARS outbreak of 2002–2003), stating
that “pregnant women should be considered an at-risk population for
COVID-19.

24. Precautions for all pregnant
women
◉ Social distancing-at least 1 meter
◉ Avoid unnecessary visits outside home
◉ Avoid contact with people suffering from viral
illnesses
◉ Practise Hand hygiene, Respiratory hygiene,
◉ Avoiding touching the face
◉ Work from home

25. 25
ROUTINE ANC CARE
IN
TIMES OF COVID

26. Routine ANC Visits Basic
Principles
◉ Routine Antenatal visits to be kept minimal
◉ Consultation on phone or video conferencing
◉ Come alone or keep the number of people
accompanying to one
◉ Follow hand hygiene,wear masks and
gloves,frequent hand sanitisation pre and post
visit

27. 27
MFM GUIDANCE FOR
COVID 19

28. Modified ANC routine In Current scenario
◉ 75 gm 2hr GTT instead of 50 gmGCT
◉ Cell-free DNA screening (at >10 weeks) rather than the combined test (ie,
nuchal translucency on ultrasound and serum analytes)
◉ Fetal kick counts hand outs to be given
◉ Teleconsultation
◉ Home BP monitoring
◉ Screen for symptoms on phone . Patients who are symptomatic, suspected or
COVID19 positive within the last 2 weeks.Phone Triage.
28
MFM GUIDANCE FOR
COVID 19

29. Suggested
timing/frequency of
growth ultrasounds
in pregnancy
29

30. ◉ Summary of common indications for
antenatal surveillance and adjusted NST
recommendations in setting of COVID19
pandemic
◉ ACOG MFM Guidance
◉ 2020
30

31. 31

32. 32

33. Indications for testing COVID 19 in pregnancy-ICMR
1. A pregnant woman who has acute respiratory illness with one of the
following criteria:
◉ a history of travel abroad in the last 14 days (6 March 2020 onwards).
◉ is a close contact of a laboratory proven positive patient or
◉ she is a healthcare worker herself or
◉ hospitalized with features of severe acute respiratory illness.
2. A pregnant woman who is presently asymptomatic should be tested
between 5 and 14 days of coming into direct and high risk contact of
an individual who has been tested positive for the infection.
33

34. Rapid Tests Guidelines
◉ In hotpots/cluster as per MOHFW and in large
migration gatherings/evacuees centers
All symptomatic ILI(fever,cough,sore throat,runny
nose)
a.Within 7 days-rRT-PCR
b.After 7 days –Antibody test(If
Negative,confirmed by rRT-PCR)
34

35. Test Method
◉ CDC recommends collection of a nasopharyngeal swab specimen
◉ Detected by reverse-transcription polymerase chain reaction (RT-PCR)
◉ Centers authorized by the government of India and state governments
◉ false negative rate of 10-30% even with two serial swabs
◉ In the near future, testing may be conducted by Nucleic Acid Ampli cation
Test (NAAT) or by serological testing.
◉ Serology faster and cheaper stay positive even after
3 weeks of infection
35

36. Course of COVID 19 In Pregnancy
◉ Most women have mild or moderate cold/flu like symptoms.
◉ Other reported cases of COVID-19 pneumonia in pregnancy are milder
and with good recovery
◉ Women with severe diseases are those who have associated
comorbidities like DM,HT, BMI>40,respiratory disease or of advanced
age
Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease
(COVID-19) Pneumonia: A Preliminary Analysis.Liu D,
AJR Am J Roentgenol. 2020;

37. Course of COVID 19 In Pregnancy
◉ At present there is one published case of a woman with severe COVID-
19 admitted at 34 weeks’, in the ICU with multiple organ dysfunction
and acute respiratory distress syndrome, requiring extracorporeal
membrane oxygenation
◉ Data from Australia have identified that there are significant increases in
critical illness in later pregnancy, compared with early pregnancy
◉ Liu Y, . Clinical manifestations and outcome of SARS-CoV-2 infection
during pregnancy. Journal of Infection 2020;
37

38. Pregnancy complications due to COVID
◉ Meta analysis by Mascio D,Am J Obstet Gynecol MFM. 2020; 41 covid positive
pregnant women were studied
◉ Maternal
◉ preterm birth <37 weeks (41.1 %),
◉ PPROM (18.8 %),
◉ preeclampsia (13.6 %),
◉ cesarean delivery (91.1 %),
◉ data reflect small numbers, related to severe maternal illness, women mostly
intubated,may not directly due to fetal/neonatal infection with the
coronavirus
38
Baby
•Stillbirth (2.4 %)
•Admission to a NICU (10 %)
• Neonatal death (2.4 %)

39. Effect on Fetus
Very recent evidence, suggests that the virus may be
transmitted vertically( Dong L JAMA 2020) 3 out of 33
neonates born to COVID positive mothers tested
positive for corona virus
◉ Chen et al. found no evidence of COVID-19 in the
amniotic fluid or cord blood of 6 infants of infected
women(Lancet 2020)

40. Effect on Fetus
Currently, there are inadequate data on COVID-19 and
◉ risk of miscarriage or congenital anomalies or fetal
growth restriction.
◉ Data from the SARS epidemic are reassuring,
suggesting no increased risk of fetal loss or congenital
anomalies associated with infection early in pregnancy
◉ Shek CC, Pediatrics 2003 Oct
40

41. Management of COVID 19
Positive
◉ As per guideline by Indian Government,COVID 19
positive patients Based on the symptoms patient are
divided into 3 groups mild, moderate and severe.
◉ Mild cases are shifted to government designated COVID
CARE CENTER
◉ Moderate cases are shfited to Dedicated COVID Health
Center
◉ Severe cases are shifted to Dedicated COVID
Hospital

42. 42

43. 43

44. ANC Care in COVID POSITIVE
ASYMPTOMATIC PATIENT
◉ Routine appointments, scans / tests
should be delayed until after the recovery
◉ If it is deemed that obstetric care cannot be delayed until after
the period of isolation, infection prevention and control
measures should be arranged locally to facilitate care preferably
at the end of the working day
◉ If ultrasound equipment is used, this should be decontaminated
after use in line with national guidance
44

45. Management of COVID Gravid
not in Labour
◉ Symptomatic
◉ Medical: Supportive therapy: rest, oxygen supplementation, fluid
management and nutritional care as needed. Maternal oxygen
saturation (SaO2) should be maintained at ≥95 percent during
pregnancy,
◉ Fetal Survellience: a Bluetooth-enabled external fetal monitor can
transmit the fetal heart rate tracing to the obstetric
provider. (ACOG) MONICA NOVII WIRELESS PATCH SYSTEM.
Frequency as per gestation age and patient profile
45

46. ◉ Fever: Paracetamol is the preferred drug
◉ Secondary bacterial infection: pregnancy safe
antibiotics
46

47. 47
Use of medications to manage pregnancy
complications in covid positive

48. SPECIFIC MEDICATIONS
◉ Hydroxychloroquine in a dose of 600 mg (200 mg thrice a day with
meals) and Azithromycin (500 mg once a day) for 10 days has been
shown to give virological cure on day 6 of treatment in 100% of treated
patients in one study( JHMI Clinical Guidance for Available
Pharmacologic Therapies for COVID-19)
◉ Alternative dosage regimens for hydroxychloroquine are to give 400 mg
twice a day on day 1 and then 400 mg once a day for the next four days
◉ Antiviral: lopinavir-ritonavir (400/100 mg) twice daily for 14 days
no difference in time to clinical improvement or mortality
was seen ( Cao B 2020)
48

49. ◉ Side effects QTc prolongation, in particular, as
well as cardiomyopathy and retinal toxicity)
◉ Published clinical data on either of these
agents are limited.
49

50. Post recovery Follow Up
◉ Scheduled ANC care that falls within the isolation period should be
rearranged for post-isolation.
◉ If patient required hospitalisation for severe illness , ultrasound for
fetal growth surveillance is recommended 14 days after resolution of
acute illness.
◉ No evidence yet that (FGR) is a risk of COVID-19
◉ Two-thirds of pregnancies with SARS were affected by FGR and a
placental abruption occurred in a MERS case,(Wong SF Am J Obstet
Gynecol 2004

51. LABOUR MANAGEMENT
◉ MFM LABOUR AND DELIVERY GUIDANCE FOR
COVID 19 AJOG 2020
51

52. Timing of Delivery
◉ In most women with non severe illness delivery not
indicated
◉ In critically ill intubated pregnant woman >32
weeks,delivery may relieve the extra metabolic and
pulmonary load.
◉ Possible benefits of this need to be weighed against the
possible risks of worsening the systemic status with a
surgical intervention.
52
MFM LABOUR AND DELIVERY GUIDANCE
FOR COVID 19

53. Mode Of Delivery
◉ Mode of birth should not be influenced by the
presence of COVID-19,
◉ unless the woman’s respiratory condition
demands urgent delivery.

54. Labour Triage
◉ A protocol should be in place in every maternity
unit to receive pregnant women in labour or
suspected labour with confirmed or suspected
COVID-19 infection.
◉ The woman should call in advance to alert the
maternity unit about her arrival whenever this is
possible
54

55. Precaution for transmission prevention
◉ Designate rooms, or section of floor to be used for
suspected/confirmed COVID-19 positive patients
Respiratory precautions
◉ Room type: Negative pressure room is not required
◉ PPE should be used
◉ Minimize change in providers.
◉ Designate one team for COVID-19 patients.
55

56. 56

57. Precaution for transmission prevention
◉ Birth attendants should be limited to one named
contact
◉ Separate delivery room and operation theatres
◉ Neonatal resuscitation corners located at least 2 m
away from the delivery table
◉ Patient should wear mask during labour and delivery
57

58. Attendence in Labour
◉ AT first arrival:full maternal and fetal assessment should be done
◉ Assessment of the severity of COVID-19 symptoms by a
multidisciplinary team(Pulmonary,critical care team)
◉ Maternal observations including temperature, respiratory rate
and oxygen saturations
◉ CTG-fetal surveillance
◉ Inform anesthetist and Neonatologist
58

59. Care in Labour
◉ Maternal vital monitoring as standard with the addition of hourly oxygen
saturations.
◉ Oxygen therapy for maternal reasons only to keep oxygen saturation > 94%
◉ RCOG recommends continous electronic fetal monitoring
◉ Oxytocin augmentation is recommended to shorten time to delivery
◉ Early intervention with oxytocin and amniotomy for slow and dysfunctional
labour
59

60. Care in Labour
◉ An individualised decision to shorten the second stage of
labour with elective instrumental birth in a symptomatic
woman who is becoming exhausted or hypoxic
◉ In case of deterioration in the woman’s symptoms assesment
of risks and benefits of continuing the labour versus
proceeding to emergency caesarean birth if this is likely to
assist efforts to resuscitate the woman
60

61. Labour management
◉ All care should be taken to reduce need for blood transfusion
◉ In addition to standard oxytocin, consideration should be made for
prophylactic tranexamic acid and misoprostol (400 mcg buccally)
◉ avoiding delayed cord clamping. RCOG recommends delayed
clamping
◉ Cord blood banking can be done(ACOG)(risk of COVID-19 transmission
by blood products has not been documented and is unclear at present)
61

62. Anesthesia Consideration
◉ Early epidural to minimize need for general anesthesia in the
event of emergent cesarean section
◉ COVID-19 is not a contraindication to neuraxial anesthesia
◉ Iv analgesia should be avoided
◉ General anesthesia is considered an aerosolizing procedure,
should be avoided,if not then special personal protective
equipment should be worn.
62

63. Infant evaluation CDC recommendations
◉ Mothers with suspected COVID-19 and unknown test results (either
pending or not tested) – infants born to such women are not COVID-
19 suspects
◉ Mothers with known COVID-19 –infants are COVID-19 suspects, and
they should be tested,
◉ isolated from other healthy infants cared for according to infection
control precautions for patients with confirmed
◉ or suspected COVID-19
63

64. Neonatal care of COVID positive patients
◉ No evidence of COVID-19 transmission through breastmilk
◉ However, given risk of neonatal morbidity from transmission through
maternal exposure, CDC recommend separation of mother and
neonate after discussion with mother
◉ Separation not required if infant tests positive
◉ RCOG and FOGSI recommends breast feeding with discussion of risk
factors with mother

65. Breastfeeding considerations:
◉ Breast milk provision (via pumping) is encouraged.
◉ The CDC recommends that during temporary separation, women
who intend to breastfeed should be encouraged to express their
breast milk to establish and maintain milk supply.
◉ Before expressing breast milk, women should practice
appropriate hand/skin hygiene washing not just hands but also
breast prior to pumping.
65

66. Period of separation- AAP
◉ until patient is afebrile for 72 hours without use
of antipyretics and
◉ her respiratory symptoms are improved and
◉ at least two consecutive SARS-CoV-2
nasopharyngeal swab tests collected ≥24
hours apart are negative.
66

67. PRECAUTIONS WHILE BREAST FEEDING
◉ Wash hands before touching the baby, breast pump or
bottles.
◉ Avoid coughing or sneezing on the baby while feeding.
◉ Consider wearing a face mask, if available, while feeding
or caring for the baby.
◉ Where a breast pump is used, follow recommendations
for pump cleaning after each use.
◉ Considering asking someone who is well to
◉ feed the baby

68. Postnatal care for COVID postive
◉ Continued medical evaluation for respiratory status and
symptoms and standard practices of routine postnatal care
◉ Hygiene related to the puerperium and hand hygiene
◉ Advice on management of engorged breasts when feeding has
not been established and measures to enhance breastfeeding
after the isolation period is completed.
◉ Healthy, nutritious diet to recover from the infection and build
immunity
68

69. Post partum care in Non Covid Patients IN
Current Scenario
Expedited Discharge Planning:
◉ All vaginal deliveries should have a goal of discharge on postpartum day 1, or
even same day if possible for selected women.
◉ All cesarean deliveries should have a goal of discharge on postoperative day 2,
with consideration of postpartum day 1 discharge if meeting milestones.
◉ Discuss anticipated maternal discharge with pediatrics/neonatology to
determine timing of infant discharge.
◉ Home care with supplies for blood pressure follow up will be critical to
expediting discharge of patients with a hypertensive disorder.
69

70. Investigational approaches in
treatment
◉ Redesmivir: nucleotide analogue that has activity
against (SARS-CoV-2) in vitro.I.V agent systematic
evaluation of the clinical impact of remdesivir on
COVID-19 has not yet been published.
◉ IL-6 pathway inhibitors no published clinical data
supporting its use
◉ Convalescent plasma
70

71. Convalescent plasma
◉ A case series described administration of plasma from donors who had
completely recovered from COVID-19 to five patients with severe
COVID-19 on mechanical ventilation and persistently high viral titers
despite investigational antiviral treatment .
◉ The patients had decreased nasopharyngeal viral load, decreased
disease severity score, and improved oxygenation by 12 days after
transfusion, but these findings do not establish a causal effect.
◉ Finding appropriate donors and establishing testing to confirm
neutralizing activity of plasma may be logistical challenges.
◉ Shen C JAMA 2020 71

72. MTP/ Abortion care services RCOG
◉ 1.4 Priority
◉ Abortion care is an essential
part of health care for women:
services must be maintained
even where non-urgent or
elective services are
suspended.
72

73. MTP/ Abortion care services RCOG
◉ Abortion is time-sensitive.
Attention should be paid to
providing care as early as possible
given gestational limits.
◉ Organise access to abortion care
so that delays are minimised
73

74. MTP/ Abortion care services RCOG
Suspected/ Confirmed COVID 19
If the woman requires face-to-face assessment but the
pregnancy is likely to be under 20 weeks’ gestation,
care should be booked after at least 7 days since the
illness started (unless she continues to be unwell,
excluding a persistent cough).
74

75. MTP/ Abortion care services RCOG
Suspected/ Confirmed COVID 19
If the woman is suitable for an early medical abortion
at home, she should be advised to take this approach if
she has no or mild symptoms (persistent cough is
acceptable), and before the pregnancy reaches 10
weeks’ gestation
75

76. MTP/ Abortion care services RCOG
◉ Suspected/ Confirmed COVID 19
If the abortion cannot be safely deferred and face-to-face
contact is necessary, request the woman attend at a specific
time (typically end of clinic, in a location that is equipped to
manage COVID-19 patients) so correct IPC (infection
prevention and control) measures can be put in place. The
woman should be given a surgical face mask to wear and
asked to wash her hands on arrival.
76

77. MTP/ Abortion care services RCOG
Suspected/ Confirmed COVID 19
If surgical abortion is performed:
Perform vacuum aspiration under LA or IV sedation
where feasible to avoid need for GA
Consider whether Spinal Anesthesia or iv sedation
would be more appropriate than an anaesthetic requiring
ventilation.
77

78. MTP/ Abortion care services RCOG
Suspected/ Confirmed COVID 19
◉ Consider checking full blood count, clotting and blood
group if unwell.
◉ Ensure that best practice is followed to reduce risk of
transmission of infection (e.g. limit number of people in
theatre, use PPE and decontaminate area after
procedure as recommended by PHE).
78

79. MTP/ Abortion care services RCOG
◉ Self-isolation due to contact with suspected
COVID-19 : same practices as described for
suspected cases to be followed
79

80. MTP/ Abortion care services RCOG
◉ Given that it is especially
important to reduce contact
during the COVID-19 pandemic,
providing a second dose of
400mcg misoprostol for
women to use 3–4 hours after
the first if they have completed
the abortion would seem
prudent.
80

81. MTP/ Abortion care services RCOG
◉ There is evidence that NSAIDs (e.g.
ibuprofen 400–800 mg) are effective
for abortion-related pain, but also
evidence that paracetamol is not.
◉ Use paracetamol in preference to
ibuprofen for symptoms of
confirmed/suspected COVID-19 but
ibuprofen can continue to be used in
other circumstances
81

82. MTP In Indian Context
◉ MTP Medication schedule H medication and cannot be
prescribed online or on Telemedicine
◉ Follow all general principles of practice as per MTP Act
◉ Assessment of patient and filling of all consent forms is
essential
82

83. MTP In Indian Context
Follow Additional Local Government
Guidelines for COVID19 as
appropriate
for example:
in Noida – it is now mandatory
to test for SARSCov2 prior to any
operative procedure.
83

84. MTP In Indian Context
◉ In Delhi: at the hospital entrance a
complete evaluation for any influenza
like illness/ travel history / contact
with suspected/ confirmed COVID19
case /hotspot area residence etc is
taken and then the woman is referred
to general OPD or a separate COVID
care centre (test not done routinely
for all operative procedures)
84

85. ECTOPIC PREGNANCY : Mx in COVID 19 PANDEMIC
Prefer Medical management If not possible avoilaparoscopy
proceed with minilap
Concerns re Methotrexate as it Is a
immunosuppresant. Is self isolation required?
No because it is approx two one off doses in
women who have healthy Immune systems
Rare cases WBC count can fall so
Follow up is must
85

86. HCW PROPHYLAXIS
86

87. 87

88. 88

89. 89