Introduction
Since December 2019, the Coronavirus Disease 2019 (COVID-19) has affected more than 190,000 and has caused over 7800 deaths. (1) As this emerging disease has rapidly increased in numbers of cases and deaths globally, the World Health Organisation has declared a pandemic on 11 March 2020.
Since the first case of COVID-19 diagnosed on 23 January 2020 in Singapore there are now 313 cases of COVID-19 diagnosed. The majority of cases are stable and have been discharged, while 15 cases are still in critical condition (0·05%). There are currently no mortalities reported.(2) Singapore’s aggressive response and containment of the outbreak has been singled out for praise by the World Health Organisation.(3) In particular, Singapore’s approach for case detection has also been cited as the gold standard in an epidemiological study.(4)
Whilst there have been reports on COVID-19 in the non-pregnant population, data is limited on the effects of the disease in pregnancy. Previous studies on the effects SARS on pregnancy have shown an increased risk of adverse maternal and neonatal complications such as maternal mortality, spontaneous miscarriage, preterm delivery and intrauterine growth restriction.(5) However, pregnant patients with COVID-19 were found to have fewer adverse maternal and neonatal complications compared to SARS.(6) The pregnant mother and her newborn baby should be considered as important high-risk populations when drawing up protocols for prevention and management of COVID-19. Firstly, physiological changes in the pulmonary system predisposes pregnant mothers with respiratory infection to poorer outcomes compared to their non-pregnant counterparts. Data is scarce on the risk of mother-to-child transmission although studies have reported no known cases of vertical transmission thus far.
In Singapore, our maternity centre at Singapore General Hospital has devised and implemented contingency protocols to manage any suspected or infected COVID-19 pregnant mothers. These protocols were based on epidemiological findings and the impact of the infection on the pregnant mother, and serve to ensure the safety of our frontline healthcare workers.