‘Healthy, emotionally strong women shouldn’t let the pandemic derail family planning’

Dr Payal Agrawal, a gynaecologist and obstetrician as well as an infertility and IVF specialist, has been part of a team which treated over 50 Covid positive pregnant women at Kingsway Hospital since the outbreak of the pandemic. Many need hospitalization and even ICUs during the second wave. In an exclusive interview to TOI, she talks about the challenges gynaecologists face and the patient’s ordeal.
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Q. How badly has the second wave hit expecting women?
A. There are no statistics available regarding the number of pregnant women hit by Covid across India. But, from anecdotal references, we have seen it was worst during the second wave. As per an article in Lancet, the number of maternal deaths has increased. The article states that more number of maternal and still births took place as compared to the pre-pandemic times. Similarly, we also noticed a little increase in maternal deaths in Nagpur district. Yet, Covid per se doesn’t affect pregnant women only but the incidence was the same as seen in the general population. The need for critical care and ICUs was more due to complications.
Q. Should teleconsultation still remain a preferred option?
A. Teleconsultation is good to a certain extent. But, if patient is not educated and not compliant, then a personal visit is required. First and second trimester there is nothing to worry but if a woman has comorbidity she should go to the hospital and consult the doctor. Generally, third trimester is more risky.
Q. What were the challenges of prenatal care management in the second wave?
A. There were two aspects. One is patients were reluctant visit hospitals because of the infection fear and doctors too recommend that they must limit their outings. This led to some challenges in routine prenatal care. Possibly, some complications may have gone unnoticed, including maternal and fetal. The other aspect is the surge. As a general scenario, hospitals were not prepared enough to deal with the kind of patient load seen in the last two months. In peri-urban areas, hospitals were not even equipped to handle Covid-related complications in pregnancies. So, the referral load increased in city hospitals. This included infrastructure and manpower.
Q. Was there a lack of proper planning for pregnant women?
A. It was unpreparedness absolutely. People were going wherever they got a bed. I am not sure if they got a chance to consult same doctor whom they had been consulting since the start of pregnacy. Ironically, Covid patients couldn’t go to their doctors while nursing homes got converted and couldn’t call their patients who were Covid-free. A gynecologist friend of mine was Covid negative. She was under treatment of some doctor whose nursing home was converted into a Covid hospital. At the last moment, she got shifted under my care and we successfully delivered her.
Q. Were the exclusive healthcare facilities not enough?
A. Certainly, enough healthcare facilities for ANCs are available in Nagpur district. But they were occupied with non-Covid ANCs as they too are equally important. Where would they have gone if these too were converted into Covid hospitals.
Q. How did you manage to treat pregnant Covid positive patients?
A. Patients who came early were successfully managed, either in the form of home monitoring with some video consultation and medicines. We managed them successfully if they had a moderate disease requiring O2 support. Some patients even required ICUs and they came out without any harm to the fetus. Some cases reported reduced quantity of amniotic fluid because of Covid. This lead to preterm deliveries. In the first trimester, the number of pregnant women having miscarriages increased in the last two months. Either directly due to Covid or due to its symptoms.
Q. What kind of precautions is necessary?
A. As such there is no special care other than the universal formula of SMS (social distancing, mask and sanitizer).We must ensure that expecting women don’t get infected and are early in reporting symptoms. Keeping a watch on bothersome symptoms like SPO2 less than 94 , persistent fever for more than 4 days, breathlessness or chest pain is the key to keep yourself safe.
Q. Ahead of a possible third wave, what is your advice for family planning?
A. Conception (pregnancy) is deeply a personal choice. Multiple factors play a key role in the pregnancy decision like social, environmental, psychological and financial. During this time of uncertainty, the best people to guide regarding your conception plans are your partner, your support persons, your own self and of course your doctor. Here, we feel the virus is still very new. We don’t know its major impact on pregnancy and its outcome. However, there are a few things a couple needs to keep in mind — mental and physical health and social and financial planning.
Q. Should couples talk to doctors at least once?
A. Generally, 10% of women experience anxiety during pregnancy which has increased to more than 30 % during pandemic times. Isolation, quarantine, all these can aggravate anxiety. Anxiety can lead to depression, which makes it difficult to manage and any healthy pregnancy can get complicated. We don’t know how long Covid will last. So, if women who are reasonably healthy and can manage emotional challenges of pregnancy should not allow this pandemic to derail their family planning. But, if somebody is suffering from any physical or mental health then they should consult their doctor while planning and have proper preconceptional counselling.