Covid-19 guidelines for pregnant women to be updated

Updated Covid-19 guidelines for pregnant women are to be issued shortly in response to new evidence of the risk the virus poses for the foetus.

The Royal College of Physicians in Ireland (RCPI) says it hopes to publish new recommendations for expecting mothers next week following consultations with obstetrician and pathologist members.

The recommendations are likely to advise stronger measures to ensure pregnant women are not exposed to the virus, in light of seven cases of Covid-related placentitis reported in Ireland.

The seven cases reported by pathologists ended in stillbirth on six occasions, while in another case the baby was born safely after emergency intervention.

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About 60,000 births have occurred over the duration of the pandemic.

The placentitis cases all occurred this year so it is likely the infection involved the B117 variant which has become dominant in Ireland since Christmas.

Stillbirth

Last month, the National Public Health Emergency Team reported four cases of placentitis resulting in stillbirth, which were identified by hospital pathologists. The number of cases has since increased to six, The Irish Times reported on Monday.

At the end of March, the RCPI said further analysis of the data relating to maternal and foetal outcomes during and after Covid-19 infection was warranted. This would inform recommendations for vaccination of pregnant women not already identified for prioritisation, such as healthcare workers and those with very high-risk conditions.

This was being addressed “as a matter of urgency”, the institute stated at the time.

More than one-third of the international reports of the condition are from Ireland. In the UK, the Royal College of Obstetricians and Gynaecologists says it has yet to come across cases linking Covid-19 to inflammation of the placenta and stillbirth. “Further studies are needed to see if this phenomenon is real,” a spokesman told The Irish Times.

“This is real and the Sars-CoV2 link is clear,” Prof Keelin O’Donoghue of Cork University Maternity Hospital said.

Stillbirths had been seen in other countries experiencing outbreaks with the B117 variant but had not yet been formally reported, she continued.

In Ireland, it is standard practice now to conduct a postmortem on a stillbirth, but in many other countries this happens only rarely.

‘Foetal compromise’

Prof O’Donoghue is co-author of a study of one pregnancy that was complicated by Covid-19 infection leading to reduced foetal movements, which concluded with a successful Caesarean delivery.

“Sars-Co-V-2 placentitis is an uncommon but readily recognisable complication of maternal Sars-CoV-2 infection that may be a marker of potential vertical transmission and that may have the capacity to cause foetal compromise through a direct injurious effect on the placenta,” according to the study.

Pregnant women need to avoid Covid-19 and access vaccination for protection, Prof O’Donoghue advised.