A new type of coronavirus pandemic is gaining momentum and the total number of infected cases has now already exceeded two million people. Even though the news about the Covid-19 infection haunts us regularly, there seems to be a lack of competent information from specialists. In this article, we will try to provide some information about the challenges faced by obstetric services and answer current questions of women in pregnancy and those who desire to conceive.

Is an intrauterine SARS-CoV-2 infection of the fetus possible?

At the moment, more than 100 pregnancies and births have been described from patients with Covid-19, and in no case a vertical transmission of the infection from mother to fetus was described. In these studies, a smear from the larynx of the baby, placental tissues and the amniotic fluids were negative for coronavirus. One publication reported the detection immunoglobulins in the blood of newborns as signs of an intrauterine infection, this data requires re-examination and further study.

Breastfeeding and postpartum period. Should mother and child be separated?

In various countries of the world, SARS-CoV-2 mothers’ milk was tested for the presence of the virus, always with a negative result. During the SARS (Severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) epidemics, these viruses were not detected in milk. Considering the data and recommendations from the leading gynaecological organizations (FIGO, DGGG, WHO, RCOG, ISUOG), at the moment it is recommended breast-feeding or expressing the milk. In this case, it is necessary to follow hygiene rules: washing hands before and after feeding the baby and also wearing a mask during the procedure. The benefits of postpartum mother-to-child contact and advantages of breastfeeding outweigh the risks of transmitting the virus from mother to child, but only if the hygiene rules for preventing contact transmission of the infection are followed.

Is pregnancy an independent risk factor for Covid-19 disease and are pregnant women a risk group for this viral infection?

Pregnancy is a special and unique state for a woman’s immune system: The maternal immune system does not reject the fetus and at the same time produces an adequate response to microbes, viruses and other pathogens. A successful pregnancy depends on this systemic and local immune adaptation. During pregnancy, the mother’s immune system goes through a series of periods in which it may be more susceptible to the virus and strong inflammatory responses. Despite these hypothetical risks, the data are currently encouraging - a very low mortality rate amongst pregnant women and the disease rarely takes a severe course.

Delivery and anaesthesiology in obstetrics

The question is often asked whether vaginal delivery is possible or whether it is possible to carry out caesarean section in infected patients. At the present moment vaginal delivery is possible, virus transmission during childbirth has not been described. In case of caesarean section, the priority should be the operation, if possible, under epidural, spinal or combined anaesthesia. In view of the risk of pulmonary complications, intubation should be avoided, and accordingly, the obstetrician should be held accountable for the timely assessment of obstetric risks, in order to avoid emergency caesarean section under general anaesthesia.

Prenatal testing during a pandemic. What you should know ...

Medical care for pregnant women should be provided and guaranteed during the Covid-19 pandemic. This includes the organization and conduct of prenatal screening and diagnosis. Indications for in-depth prenatal diagnosis in patients at high risk remain unchanged, at the same time, if necessary, these indications should be critically re-examined. Unnecessary contact between potentially infected medical staff and potentially infected patients should be avoided. During consultation and ultrasound, institutional (if any, national recommendations) protective measures to prevent transmission of the virus should be followed. International recommendations on the use of PPE (personal protective equipment) are the same in the case of an alleged or proven Covid-19 disease. In this situation, prenatal care for a pregnant woman should be limited to necessary examinations to monitor the “condition of the fetus”, invasive interventions should be postponed if possible. During consultation, the physician should inform the pregnant woman and provide access to reliable information in order to avoid stressful situations.

A large number of patients from foreign countries underwent treatment and diagnosis at the Department of Obstetrics and Gynaecology of the Medical Center-University of Freiburg. Are there any relevant alternatives in the context of restrictions on interstate movement?

In order to permanently provide qualified services to our regular and new customers with the support of the International Medical Service (IMS Freiburg), we have expanded the bandwidth and technical capabilities in the field of telemedicine. The oncological advisory service, as well as the “second opinion” service, continues to be provided at the highest level. The interdisciplinary oncological conferences continue on a weekly basis.

Activities aimed at organizing access for Russian-speaking audiences to verified scientific information.

Unfortunately, the Russian-language Internet, like many other segments of the World Wide Web, is full of fake news and pseudoscientific publications about coronavirus. Seeing this situation, we decided to fill this information vacuum and create a Russian website (www.covid19pregnancy.org), where all the scientific information on the organization of obstetric care during the covid-19 pandemic would find its place. There is also a blog on the site where we write reviews on articles about coronavirus and pregnancy. By this we try to convey information to our colleagues who do not speak English.

Communications between countries are interrupted. Is scientific cooperation possible?

Contrary to closed borders, modern technologies allow specialists from different countries to be in continuous contact and design research projects without leaving their office. Especially for doctors and healthcare professionals, we have a chat on our website, as well as an email address for contacts on the topic of scientific cooperation: covid19pregnancy@gmail.com

In conclusion, despite the difficult global epidemiological and economic situation, the gynaecological department of the University Hospital Freiburg continues to fully provide obstetric and gynaecological care to the population of the city and the region. We introduced interactive and innovative methods of consultation, and expand the range of telemedicine services by creating an Internet platform for the exchange of views and knowledge in Russian.

M. Hasanov, M. En-Nosse, E. Bäz, M. Klar, M. Kunze, I. Juhazs-Böss

Department of Obstetrics and Gynaecology, Freiburg Medical School, University of Freiburg