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Interview : Dr Usha M Kumar Senior Consultant, GynaeFriday April 17, 2020 at 5:46 pm
Dr Usha M Kumar is the director of the Progeny clinic in Lajpat Nagar and the best Gynecologist Laparoscopic surgeon in Delhi, Max Smart Hospital. She is super-specialized in endoscopic procedures for infertility and for cancer patients. She completed her qualification of MBBS and MS (Gynecology) and was the recipient of the “Excellent performance award”. Medical Darpan is glad to involve in chit-chat with her on the pregnancy during COVID-19.
MD : During COVID-19, what are the extra precautions pregnant females should take?
Dr.Usha: If you are pregnant and want to take the medical care you should be taking extra precautions during your pregnancy because this COVID-19 pandemic is everywhere. First of all, we have limited hospital visits to Antenatal patients. At the first visit, you can confirm the pregnancy test if the urine pregnancy test is positive. You can visit the hospital for the first ultrasound just to confirm whether the pregnancy is there in the uterus and to confirm the heartbeat. Second visit you can do around 12-13 weeks for the Down syndrome screening because this is a very important time to do the NT scan and do the Double markers to rule out the Down syndrome in your baby. Then the third visit is going to be around 19-20 weeks of the pregnancy just to check for the baby’s anomalies and for your tetanus injection. If you are having no other co-morbidities like for example, you have no history of high blood pressure, diabetes, Asthma or cardiac problems or you are on not Immuno-suppressant drugs as in cases of kidney problems or liver problems then another visit may be required at 34or 36 weeks of the pregnancy just to check the growth of the baby and blood flow to your baby as Doppler scan and in the 39th week just to plan the delivery. Very important, to watch Fetal movements from 32 weeks onwards because you should be careful about baby movements. Decreasing baby movement is the first sign that your baby is not doing well. So your baby should move at least 12-14 times in a day and you should be maintaining one kick chart just after having breakfast, lunch, and dinner starting after 32weeks. Anytime you feel the baby movements are not good enough or not 10-12 times or less than 10 in 24hours then I think it is a good idea to inform you are concerned doctor or contact the labor room. Blood pressure checking is also important because again you will not be able to go to the hospital routinely to get your blood pressure checked. So if you can do it from home, starting after 32 weeks it is a good idea. If you have any doubt you can talk to your doctor through teleconferencing or video conferencing to clear your doubts. So if you are visiting the hospital, it is important you are disclosing to your gynecologist about your travel or contact history. So if you have had any traveling even in your private vehicle or public transport with many people around or visited shops or areas where you came in contact with the patient who has lab conformed COVID-19 test you should be declaring that to your doctor. If you have any symptoms like if you have any history of sore throat, running nose, coughing or fever please declare to your doctor.
What are the immediate things pregnant mothers or family members should do, if they feel labor pains during this lockdown.
Dr.Usha: First of all, it is important to identify if these are true labor pains or false labor pains. False labor pains mean, the pain can come and go off and it doesn’t last for a long time. But in true labor pains, the pain is there and every time it is coming the intensity is more and more. Another thing is you have pain along with the pain you have blood stain discharge vaginally or water is leaking vaginally. These are the two signs of true labor pain. It is a good idea to inform your concerned doctors or health care workers in advance because in COVID-19 times they have to be prepared for your delivery beforehand. So please inform them beforehand. If you are really in the position that you cannot go or the private vehicle is not available you can even call emergency then ask them to send an ambulance at your doorstep and they can pick you up and they can take you to the labor room. So informing your concerned doctor and going to the labor room is very important if you are having true labor pains
How safe it is to conceive during these days?
Dr.Usha: As far as his safety is concerned whether to get pregnant during these days or not we are not sure. Because whatever the studies have been published so far they have done it in the second trimester or third trimester. We don’t have the literature to support or say that if it’s going to have a bad effect on your baby in case you’re COVID-19 positive or are a carrier of the Covid-19 virus. The thing is since we are not aware of its consequences it is better not to try and get pregnant these days. Not only because it can affect your baby but other things like, in case you happen to have an ectopic pregnancy- a pregnancy in the tube, not in the uterus- or in case you end up in a miscarriage, again you are exposing yourself into the risk of catching infection because you have to go to the hospital where you will have to come in contact with other patients as well as the health care workers so again the chances of catching the virus are high and you know all of us are trying to maintain social distancing. If you can avoid pregnancy then please do.
What if, pregnant women could not get all the requisite vaccinations during pregnancy due to lockdown?
Dr.Usha: The vaccination that we give during pregnancy is flue and another is the tetanus toxoid vaccine. So if you are not able to take tetanus toxin vaccine it best that when you reach the hospital anytime or if you are able to contact your health worker or gynecologist then please inform them. They can take the required precautions. It can be given even after the birth of the baby and in that case, it can be given separately to the mother and child. So it is important to inform your gynecologist or the concerned pediatrician.
What are the immediate precautions that should be taken post-delivery during these days?
Dr.Usha: Post-delivery, I think it is better to continue practicing social distancing and hand hygiene along with respiratory hygiene. If you have any symptoms or any history of contact with the COVID-19 positive patient, then it is a good idea to get your testing done for the Nasopharyngeal swab test the PCR Test or another test that is available in the Rapid Testing to check the antibodies. So even if the test is negative then also please continue taking precautions because there is a 30% possibility that the test can be falsely negative. In the Postnatal period, the main concern is to breastfeed the baby. So important question is how to breastfeed the baby? This can be done in two ways. If you are really asymptotic and the COVID-19 test was also negative then also take all safety precautions, hand hygiene and not to remain in close contact with the baby. Close contact is a distance less than 1 feet n for more than 15 minutes. So practice all safety precautions and if you have any doubts about COVID-19 infection then, in that case, other ways of feeding to the babies can be opted like using expressed milk for feeding. Actually feeding is important and breast milk builds the baby’s immunity and so far we don’t have any evidence to say that the COVID-19 virus is positive in breast milk. So breast milk can be given, the good idea is to practice all safety precautions and use expressed milk. In