Coronavirus Information for You and Your Patients
Dear Obstetric Shared Care GPs,
The COVID-19 pandemic is unfolding so rapidly. At each antenatal consultation you are probably being asked by worried patients what it means for them, and their babies. It is clear we all need answers, based on reputable scientific sources.
The trouble is that we are besieged with facts, but a depressing mix of true facts published in journals sprinkled with a few untruths (e.g. rife vertical transmission has been one doing the rounds).
How are our GPs who are coming to grips with PPE, keeping their families, patients and colleagues safe meant to keep on top of the rapidly expanding literature?
GP Partners is going to do our best to help.
We start with sourcing three papers that will be of keen interest to your patients and we hope for you too.
Paper 1: Early reports show pregnancy outcomes may be reassuring
- Systematic review including 19 studies (mostly from China) – data on 79 hospitalised pregnant women affected by Covid infections (41 COVID-19, 12 MERS, 26 SARS)
- Most common symptoms included fever, cough and dyspnea with 92% reported to have pneumonia.
- There was an overall rate of 12.3% maternal death when ALL the coronaviruses were included, including the higher mortality MERs and SARS.
- Preterm birth was the most common adverse pregnancy outcome (24% <37/40), with increased rates of preeclampsia (16%), FGR (12%) and miscarriage (39%), but reported across ALL CoV infections
For COVID-19 specifically, outcomes appear reassuring around 42 cases:
- For COVID-19 only 9% ICU admissions and 0% maternal deaths
- For COVID-19 alone there was insufficient data on first trimester outcomes or rates of FGR/PE
- For COVID-19 alone there was a perinatal loss rate of 7% (2/41), but the confidence interval is wide.
- For COVID-19 there was a 0% rate of vertical transmission (0/42)
- For COVID-19 there was a 41% rate of preterm birth <37 weeks. However, while not made clear in the review, it is possible many of these were iatrogenic where the clinical staff deliberately delivered the baby for maternal indications.
Take home message – there may be an increased risk of preterm birth amongst women hospitalized with COVID-19. Overall, outcomes seem reassuring.
Also, we suggest growth surveillance after recovered COVID-19 should be considered, and probably CEFM in labour, but mainly based on data from the other covid infections.
Paper 2: Children seem to do okay with COVID-19
- Systematic literature review of 44 relevant scientific papers (and 1 letter-to-Editor, NEJM) published between 1st Jan and 18th Mar 2020, with the majority of data from China.
- Children (<19yrs, median age of diagnosis 7yrs) have so far only accounted for 1-5% of COVID-19 diagnoses.
- The majority of children with confirmed or suspected disease were asymptomatic or had mild-moderate symptoms, including cough, sore throat and low-grade fever, or less commonly (<10%) diarrhea, vomiting, rhinorrhea and myalgia.
- Severe disease in children was rare – the largest study to date (>2,000 children) reported only 5.2% with severe disease and 0.6% in a critical condition (respiratory failure, shock or multi-organ failure).
- Only two deaths in children less than 19 years old have been reported in the literature to date
- Newborn cases have been reported – the data are scarce, but the studies reported nil evidence of vertical transmission.
- There is currently insufficient evidence to comment on the prevalence of comorbidities in those children affected.
- COVID-19 in children appears to be milder than in adults, their prognosis is better and deaths are rare, although this may be altered today with 2 deaths reported, one in Belgium and the other in the UK.
Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Yu et al. Lancet 24/03/2020
(Click link here for access to full text)
- Seven patients presented with fever (6/7), cough (1/7), shortness of breath (1/7) and diarrhoea (1/7). Co-infections were present in three patients, two with H1N1 and one with Legionella pneumophila.
- Maternal outcomes were again similar to non-pregnant COVID-19 patients and none required ICU admission.
- All women were delivered via caesarean section from 37 – 41+5 gestational weeks.
- Neonatal birthweights and Apgar scores were normal.
Of the three neonates tested for SARS-CoV-2, one returned a positive swab within 36 hours of delivery. However, cord blood and placenta samples from this patient were both negative, suggesting this may not have been due to vertical transmission.
Please feel free to share this with your clinical colleagues and Practice Nurses/Midwives who may be interested. Don’t forget to visit our GP Partners Australia website for further updates and resources www.gppaustralia.org.au
We trust this – and future updates – will be of help during these unsettling times.
If you have any questions or require additional information please do not hesitate to contact the GP Obstetric Shared Care Program Manager – Leanne at email@example.com