1) Relevant advice for health care-givers, mothers-to-be

GS 2- Health Issues:

Context:

With COVID-19 compounding maternal and neonatal complications, vaccination and special facilities must be priorities

What’s the matter?

Maternity services in India, both public and private, already overburdened with large numbers even in pre-COVID-19 times, face a crisis situation with the conditions caused by the pandemic.
Currently, the number of new cases of COVID-19 per day and the number of daily COVID-19 deaths in India are among the highest in the world.

A danger

Recent reports from Kerala on pregnant mothers, have uncovered many serious medical problems faced by pregnant women like: pre-eclampsia, pre-term labour maternal infections, increased caesarean section rates, fetal growth restriction due to placental insufficiency, still births, neonatal infections and respiratory distress.
According to a recent publication in the Journal of the American Medical Association, maternal mortality is several-fold higher in COVID-19 positive pregnant mothers than in non-COVID-19 pregnant women.
Many pregnant women need admission to the intensive care unit and prolonged hospitalisation.
There is an urgent need for action from professional bodies to avert a serious calamity.
Government, in consultation with these bodies, should immediately facilitate counselling and care for women in the reproductive age group.

Steps to be taken

With the massive increase in numbers of COVID-19 infections with the second wave of the novel coronavirus , this important matter should be taken up on a war footing, alerting women in the reproductive age group and the medical profession.
Two important steps must be considered immediately: Advise all women to postpone pregnancy till both partners are vaccinated; Offer vaccination to all un-vaccinated pregnant women.
The demands on health-care personnel who provide antenatal care would decrease; they can be redeployed for COVID-19 care and the vaccination programme.
Reduction in the number of antenatal visits, online consultations, protocols for ultrasonography, glucose tolerance test and antepartum fetal evaluation must be followed by all caregivers.
Dedicated and safe ultrasound scan centres for pregnant women, manned exclusively by immunised personnel (either vaccinated or after recovery from previous COVID-19 infection) is a need of the hour.
Pregnant women with fever should be considered to have COVID-19 unless proven otherwise and be taken care of in triage areas with all personal protective measures in place till COVID-19 test results are available.
COVID-19 pregnancies and non-COVID-19 pregnancies should be handled in different settings to prevent infecting susceptible mothers.
Unvaccinated health-care workers providing care for pregnant women should be quickly vaccinated.

Clear benefits of vaccination

The health authorities in the United Kingdom and the United States have realised the benefits and the safety of vaccinating pregnant women and have approved vaccination of all pregnant women with mRNA vaccines.
Inactivated virus vaccines are safe during pregnancy and the World Health Organization has given a nod to the use of the inactivated Synovac vaccines.
Therefore, the inactivated vaccine available in India (Covaxin) may have advantages over the vectored vaccines (Covishield and Sputnik) for vaccinating pregnant women.
The availability and advantages of the vaccine for pregnant women should be publicised and awareness should be created among the public.
Vaccine hesitancy in pregnant women is likely to be much higher than in the general population — this should be addressed by information, education and effective communication.
Professional bodies recommended to the Ministry of Health and Family Welfare that vaccination be offered to pregnant women after providing adequate information and counselling — and the Indian Council of Medical Research and the Ministry of Health have approved this, welcome steps in the right direction.

Conclusion:

India will do well to enhance vaccination coverage of couples planning pregnancy and pregnant women on a priority basis in order to protect mothers and their new-born.