The alarming rate of COVID-19 among pregnant women in Pakistan

Rooh Ullah1, Fawad Shabir Memon2, Samiaa Anjum3
1-Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.
2-National Institute of Health, Islamabad, Pakistan. Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology (SZABIST), Karachi, Pakistan.
3-Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.

Correspondence: Rooh Ullah, M Phil, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan; E-mail: roohullah@bs.qau.edu.pk

Citation: Ullah R, Memon FS, Anjum S. The alarming rate of COVID-19 among pregnant women in Pakistan. Anaesth. pain intensive care 2020;24(4):471-472. DOI: 10.35975/apic.v24i4.1325


In the previous two months, a rapid increase in the number of COVID-19 patients has been observed in various cities of Pakistan such as Gujrat, Lahore and Karachi. The pandemic exhibits a peculiar challenge to the obstetric community, as most of them have to be admitted to a hospital for normal or cesarean delivery. There link with the medical care system starts right from the start with the much needed antenatal visits. On 15th March 2020, first pregnant woman was diagnosed with COVID-19 in Pakistan.1 This was followed by the implementation of universal testing protocol including nasopharyngeal swabs and quantitative polymerase-chain reaction (q-PCR) for the sole purpose to detect the SARS-CoV-2 infection in obstetric women admitted or in need of admission to a hospital for childbirth.
From 29th March to 9th May 2020, 303 deliveries were conducted at the Government Maternity Hospital (GMH) Gujrat, Basic Health Unit (BHU) Fatehpur, Shaikh Zayed Hospital Lahore and DUHS Hospital Karachi. At the time of admission to the hospitals, COVID-19 symptoms were screened in all the pregnant women and it was reported that raised temperature, along with many different symptoms, was observed in 98 (32.3%) of them. Out of these 98 women, COVID-19 was positively detected in 28 (28.5%) pregnant women.
The rest of the 205 (67.6%) women did not reveal a raised temperature or any of the symptoms at the admission time. Out of these 205 asymptomatic parturients, 3 (1.4%) were detected to be positive for the COVID-19. Hence, of the total 303 patients, 31 (10.2%) obstetric women were screened positive.
Out of the three women who did not have any symptom of the disease, but were still positive for the infection at the time of admission, only one patient developed fever before her discharge from the hospital after the delivery (2 days are the average length of stay after the childbirth). Antibiotics were received by one of the other two parturients, for the treatment of suspected endometritis. The patient, who was assumed to be febrile due to COVID-19, received supportive treatment.
The implementation of testing protocols for the detection of the virus in the pregnant population at the time of admission to the hospitals for delivery indicated that in Pakistan, almost 33% parturients displayed various symptoms of the disease. Although this finding cannot be generalized to geographic areas with lesser infection rates, it emphasizes the COVID-19 risks amongst symptomatic pregnant patients.2 A limited availability of data from whole of the country along with false negative test results, might lead us to underestimate the exact prevalence of the infection; but still the COVID-19 prevalence among the pregnant women seems to be alarming.3
The use of testing practices at the admission time provides the possible advantage allowing us to reassess hospital isolation procedures, pre-empt the bed assignments, to notify newborns service centers and give guidance about the usage of personal protective materials. Collection of similar clinical data is needed to ensure safety of the infants, mothers, as well as healthcare workers during this difficult period of pandemic.

References
  1. Javaid S, Javaid MK. Survey on corona virus: a case study in Pakistan. International J Med Sci Clin Res 2020 Apr 17;3(02,):223-227. [Free Full Text]
  2. Sutton D, Fuchs K, D’alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Eng J Med. 2020 May 28;382(22):2163-2216. [PubMed] DOI: 1056/NEJMc2009316
  3. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology. 2020 Aug;296(2):E32-E40. [PubMed] DOI: 1148/radiol.2020200642