Discussion
The pregnant mother is at higher risk of a poorer clinical outcome from pneumonia compared to their non-pregnant counterparts. The Spanish Flu pandemic in 1918, the Asian flu epidemic in 1957 and SARS in 2003 have shown higher mortality rates from 25% to 50%. (5,17,18) Physiological changes during pregnancy increases the risk of severe respiratory compromise. The gravid uterus has been shown to elevate the diaphragm by 4cm in the third trimester, reducing the functional residual capacity. In addition, oxygen consumption is increased by 20% leading to an intolerance of hypoxia. These lead to rapid deterioration of a pregnant mother during severe respiratory infections leading to possible iatrogenic preterm delivery. (19)
The fetus is also at risk of a poor clinical outcome. While little is known on the risks of miscarriage or congenital effects of COVID-19, increased risk of preterm delivery, fetal distress, premature rupture of membranes has been reported. (6) Although reports published thus far have shown no evidence of vertical transmission (6,20), the baby may still be exposed to viral shedding in maternal stools (21) during vaginal delivery, or to respiratory droplets from the mother.