Gynaecs warn Covid-19-recovered pregnant mothers to be wary of complications in newborn

The tweet, in just a day’s time, saw more than 3,200 retweets.

Several doctors, including many from South India, responded by reporting similar cases, and asked pregnant women to mask up to prevent Covid-19 infections.

South First spoke to doctors from southern states who said even Covid-19-recovered pregnant mothers should be wary of possible complications in newborns.

picture of the x-ray of the covid complications baby posted by the doctor on Twitter. (imacuriosguy/Twitter)

In a series of tweets, Dr Rajesh Parekh from Vadodara, Gujarat, said: “Delivered a healthy 3 kg full term baby uneventfully. Short labor, no PROM, no distress, clear liquor. Baby had persistent grunting. Shifted to nicu. Xray reveals totally white lungs bilaterally. Echo normal… [sic]”

He added: “Covid antibodies level is 1600 ( normal <1) and IgG is >200 ( normal <17). Baby is on ventilator and prognosis is grim. Mother has absolutely no symptoms. Please please, all pregnant ladies, mask up, especially in last trimester. ..I have already lost 4 babies precisely because of this #COVID19 in newborn—only one survivor. I am praying for this baby. [sic]”

#COVID19 is affecting fresh newborns. Delivered a healthy 3 kg full term baby uneventfully. Short labor, no PROM, no distress, clear liquor. Baby had persistent grunting. Shifted to nicu. Xray reveals totally white lungs bilaterally. Echo normal…

— ?????? ?????? (@imacuriosguy) September 29, 2022

Multisystem Inflammatory Syndrome in Neonates (MIS-N)

Doctors told South First that the number of Multisystem Inflammatory Syndrome (MISN) cases triggered by Covid-19 antibodies passed on to the newborn at birth by the mother turns deadly for babies.

The incidence of this was very high in Karnataka during the first two waves, said Dr Chikkanarasa Reddy, head of paediatrics at Bowring and Lady Curzon Medical College Hospital.

He said these are typical cases of foetal inflammatory response syndrome (FIRS), where the infection is passed on from the mother to the foetus.

“We saw many such cases during the second wave,” he said. “We even lost a few babies to the infection. However, now the number has come down. In September there were three cases of MIS-N with asymptomatic mothers, but all three of the babies recovered.”

Reddy told South First that these babies tend to show an increased respiratory rate and difficulty in breathing as symptoms. They can also show up with symptoms like feed intolerance, septicemia or sepsis, which is an infection in the blood, and lethargy. Some even have high fever.

“Such cases will have to immediately be shifted to NICU and also may need ventilator support,” Reddy added.

Doctors from several other states who replied to Parekh’s tweet mentioned similar instances.

Dr Prakash Kini, a senior Consultant obstetrician and gynaecologist from Cloud Nine Hospitals in Bengaluru also said that despite the mother testing negative for Covid-19, they have come across several such cases during the three waves of Covid-19.

Hence, they have now been taking utmost care and precautions while treating a patient who has been infected with Covid-19 in any of the waves.

Other complications during pregnancy post Covid-19

Kini says that they are witnessing several other complications in newborns, and not just MIS-N.

He said some otherwise healthy pregnant mothers, with no complications, even had abortions at seven months after the pandemic.

“In one case, my patient — who was in her seventh month of pregnancy — suddenly felt her baby was not moving. We did a scan and found that it was Intra Uterine Fetal Death (IUFD): The baby had died in the womb at seven months of her pregnancy,” he recalled.

“The mother had no Covid-19 symptoms and had even tested negative. So, testing negative for Covid-19 cannot be the benchmark and MIS is not the only complication,” explained Kini.

Meanwhile, Dr Gopikrishna, a paediatrician from Maharaja Agrasen Hospital in Karnataka said he had seen cases where the mother had no Covid-19-like symptoms and tested negative on her delivery, but the inflammatory markers noticed in the baby and the cardiac enzymes were abnormally high.

“Cases of mild cardiac dysfunction, premature deliveries, low birth weight babies, pneumonia in babies, and stillbirths are being seen in babies of even mothers who have had Covid-19 — whether earlier or during pregnancy,” Gopikrishna said.

‘Doctors must know about complications’

Stressing the importance of awareness of MIS-N and other complications that can arise in women who have been infected with Covid-19, even if it was before pregnancy, Kini said, “The treating gynaecologist, neonatologist, and the mother herself should be aware of the complications that could come in the patient if she tested positive for Covid-19, even if it was many months before pregnancy.”

He explained that amongst his patients, he saw several healthy pregnancies turning into complicated ones or babies developing complications immediately or a few weeks after birth in mothers who had Covid-19 earlier.

So now, there is a proper protocol that is followed.

“I document the mother’s Covid-19 infection date, ensure that throughout her pregnancy there are extra measures taken, like insisting on a few screening tests to prevent complications, and also instruct the neonatologist that the baby might develop problems and needed to be watched with extra precaution,” Kini explained.

Expressing similar views, Reddy said gynaecologists, neonatologists, AND paediatricians at Bowring Hospital are also trained on how to notice complications and take precautions and immediate actions in such cases.

“Precautions taken during pregnancy and post-delivery reduced not only the number of babies coming up with MIS-N, but the survival rate of such babies has also gone up,” he said.

He added that the medical community needed to be aware of detecting such cases quickly and initiate treatment.