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.