Move pregnant women up vaccine list, says master of Rotunda

Information on stillbirths ‘very much preliminary’, further evidence required – HSE

The HSE issued an alert after coroners identified coronavirus infection of the placenta as a factor in four stillbirths in January and February

The HSE issued an alert after coroners identified coronavirus infection of the placenta as a factor in four stillbirths in January and February

 

The master of the Rotunda, Prof Fergal Malone has repeated a call for pregnant women to be moved up the vaccination priority list.

“Putting them at the end of the queue is not a good thing,” said Prof Malone on Friday morning.

Prof Malone was commenting after a number of stillbirths among women with Covid-19 prompted separate alerts from the Health Service Executive (HSE) and the Institute of Obstetricians. The HSE alert was issued on Thursday after coroners identified coronavirus infection of the placenta as a factor in four still births in January and February.

It was not surprising to find that there had been a number of cases that may have been associated with Covid-19, said Prof Malone, but the issue was whether the cases were as a result of causation or association.

It would be difficult to conclude that Covid-19 in the placenta had caused the stillbirth, the professor told RTÉ Radio’s Today with Claire Byrne show.

Of the 200 cases in the Rotunda hospital of pregnant women with Covid-19 there had been no adverse baby outcomes, he added.

The further into the pregnancy that a woman contracted Covid-19, the higher a chance of getting very sick, which made their care “a little bit trickier” said Prof Malone.

Maternity hospitals were safe places and any woman who had concerns should contact their hospital “day or night”.

Prof Malone said he was a strong advocate for pregnant women to be vaccinated. “It’s the safe thing to do,” he said.

Internationally thousands of pregnant women had been vaccinated with no adverse effects, he said.

Contact

Speaking on Friday morning, the head of the HSE National Women and Infants Programme Prof Peter McKenna advised that pregnant women who notice decreased foetal movements should immediately contact their hospital.

Prof McKenna told Newstalk Breakfast the information was “very much preliminary” and further evidence would be required. Pregnant women should continue to avoid acquiring the virus by adhering to public health measures and if they had any concerns they should share them with their hospital where tests would be done, he said.

If the women detected decreased foetal movements it would be prudent to have tests carried out and have them repeated on an ongoing basis, he said.

However, Prof McKenna said it seemed unusual health authorities were only hearing of the issue at this stage, a year into a pandemic.

There had been thousands of births in Ireland in the past year and millions throughout the world, he said, adding if there was a frequency of such incidents it would have come to light in other countries.

While international experience showed it was “not unusual” for Covid-19 to cause placental infection, stillbirth was an “unusual complication”, Prof Peter McKenna told The Irish Times.

The fact four stillbirths had occurred in a short time and among the small population of women with Covid-19 had raised concerns, prompting the HSE to issue the alert, he said.

Good outcomes

On RTÉ Radio’s Morning Ireland, Professor Keelin O’Donoghue said the majority of cases of Covid-19 during pregnancy had very good outcomes with most women experiencing only mild symptoms and there had been no maternal deaths as a result of the virus.

There could be small clusters of cases of stillbirths “by chance”, but the data internationally was “very reassuring”. The grief of the families who had experienced the stillbirths should be acknowledged, she said.

The HSE alerts were sent to maternity staff across the country after postmortems identified Covid-19 infection of the placenta as a factor in four recent stillbirths.

On foot of the postmortem findings, two separate coroners took the unusual step of contacting the HSE directly with their concerns. The women had mild or moderate symptoms of Covid-19, but were not very unwell.

The stillbirths, which occurred in the first two months of this year, have yet to be examined at inquests, which are not bound to follow the findings of the postmortems.

Dr Ronan Glynn, deputy chief medical officer said on Thursday evening: “We have been made aware of four preliminary reports of stillbirths potentially associated with a condition called Covid Placentitis.

“These reports should be interpreted with caution as the coroners have not yet concluded their findings. The HSE’s National Women and Infants Programme is aware of and is monitoring the situation and has issued a related notice to obstetric departments.

“I would ask that the privacy of all of those affected by this disease continue to be respected at all times.”

Two of the stillbirths were included in the daily mortality figures from the National Public Health Emergency Team (Nphet) on Thursday evening.

Despite the absence of international evidence for Covid-related stillbirth, it was decided to issue the alert on a precautionary basis.