<div><b></b>Dear Editor,</div><div>Thank you for the opportunity to respond to Dr Sahu’s
letter<sup>1</sup>. We would like to thank Dr Sahu and his team
for their valuable points and ourselves recognise and acknowledge the
gaps in our early commentary<sup>2</sup> which reflected on the
early practice at our hospital, with an aim to help fellow obstetricians
with the management of COVID-19 at the start of the outbreak. Since
then, more literature has been published providing us with greater
knowledge regarding this new infection. Guidance from the Royal College
of Obstetricians and Gynaecologists (RCOG)<sup>3</sup> and
International Society of Ultrasound in Obstetrics and Gynaecology
(ISUOG)<sup>4</sup> amongst others help us streamline management
of COVID-19 in pregnant patients.</div><div>Both guidelines concur that radiographic investigations should be
performed in pregnant patients – protecting the fetus by using a
radiation shield over the gravid uterus. Chest CT has high sensitivity
up to 97% for diagnosis of COVID-19 and may be considered as primary
tool for COVID-19 detection.</div><div>Both guidelines recommend the use of antenatal corticosteroids (ANC) for
the usual indications but cautions use in critically ill women with
COVID-19 infection as it may worsen their clinical condition.
Importantly, urgent deliveries should not be delayed for the
administration of ANC.</div><div>Li et al<sup>5</sup> compared clinical characteristics, maternal
and neonatal outcomes of pregnant women with and without COVID-19. They
found that COVID-19 infection generally causes mild respiratory symptoms
in pregnant women, with no deaths or severe respiratory complications
requiring critical care. They observed a higher rate of preterm
deliveries in confirmed cases (33.3%) compared to control groups
(¬5%). This study included two patients who had vaginal deliveries
prior to COVID-19 diagnosis. Their newborns did not show any respiratory
symptoms.</div><div>New reports of SARS-COV-2 IgM in infants<sup>6</sup> at birth
suggest possibility of vertical transmission although COVID-19 infection
in newborns is more commonly likely due to neonatal transmission.</div><div>During breastfeeding, the main risk for infants lies in their close
contact with mothers and transmission of infective respiratory droplets.
Infected mothers wishing to breastfeed should do so with precautions
such as wearing surgical masks, practising good hand hygiene and
thorough cleaning of equipment after use. While the decision for
separation of mother and baby has serious consequences on bonding and
mental health, we continue to advise separation of baby from mothers
infected with COVID-19 due to risk of neonatal transmission.</div><div>Current data suggests that the adverse effects of COVID-19 in pregnancy
are less severe than those of SARS-CoV and MERS-CoV. All presently
reported patients were diagnosed in the third trimester and the
potential effects of COVID-19 infections in the first and second
trimesters remain to be investigated.</div><div>As Dr Sahu mentioned, comparative studies are scarce. Establishment of
international registries will improve our understanding of COVID-19 in
pregnancy. Meanwhile, we shall continue to support one another and work
together in the fight against this pandemic.</div><div>We would like to thank the all departments from the Division of
Obstetrics and Gynaecology, Infectious Diseases Department and all staff
in KK Womens’ and Children’s Hospital for leading the COVID-19 fight
locally.</div><div>Monica Shi Qi Chua<sup>1</sup>, Jill Cheng Sim
Lee<sup>2</sup>, Suzanna Sulaiman<sup>1</sup>, Hak Koon
Tan<sup>3</sup></div><div><sup>1</sup>Department of Obstetrics and Gynaecology,<sup>2</sup>Department of Urogynaecology,<sup>3</sup>Division of Obstetrics and Gynaecology</div><div>KK Women’s and Children’s Hospital, Singapore</div>