Obstetrics and gynaecology in the era of COVID-19

Angela Mary George, Daniel Manoj, Sowmya Ramani, Lalropuii ., Murugan Timiri Palani, Ranjit Immanuel James, Latif Rajesh Johnson


The World Health Organization has declared the outbreak of COVID-19 as a global pandemic. The alarming levels of spread and severity of the viral disease has resulted in significant morbidity and mortality. Women often face the highest risk of suffering devastating losses from the pandemic. Historically, women’s health has always been inadequately represented in responses to global outbreaks. Resources are often funnelled away from women’s health services towards targets perceived to be more important. Pregnant women with suspected, probable or confirmed COVID-19, should have access to obstetric and foetal medicine, neonatal care as well as mental health and psychosocial support, at facilities ready to tackle maternal and neonatal complications. In this article, we attempt to look at the challenges faced by gynaecologists because of this pandemic, and provide an overview on the current protocols in antenatal care, foetal care, childbirth, and oncological care.


Antenatal care, COVID-19, Fetal medicine, Gynaecologic oncology, Pandemic, Women’s health

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Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D, Piaggio G. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD000934.

Knight M, Bunch K, Tuffnell D. Saving lives, improving mothers’ care. Available at: Accessed on 20 June 2020.

Coronavirus (COVID-19) infection in pregnancy. Available at: documents/guidelines/2020-05-13-coronavirus-covid-19-infection-in-pregnancy.pdf. Accessed on 20 June 2020.

Raleigh VS, Hussey D, Seccombe I, Hallt K. Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey. J R Soc Med. 2010;103(5):188-98.

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO clinical characterisation protocol. medRxiv. 2020;2020:1-20.

GCPR on Pregnancy with COVID-19 infection. Available at: uploads/covid19/fogsi_gcpr_on_pregnancy_with_COVID_19_version_1.pdf. Accessed on 20 June 2020.

Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19. Available at: https://static1.squarespace. com/static/5e6613a1dc75b87df82b78e1/t/5eecb111fdd1e0249e31904a/1592570129615/VTE-Patients-with-COVID19.pdf. Accessed on 20 June 2020.

Pregnancy, childbirth and COVID-19. Available from: novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid-19-pregnancy-and-childbirth. Accessed on 20 June 2020.

Dong L, Tian J, He S, Wang J, Zhu C, Liu C, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020; 323(18):1846-8.

Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in infants born to mothers with covid-19 pneumonia. JAMA. 2020;323(18):1848-9.

Poon LC, Yang H, Lee JCS, Copel JA, Leung TY, Zhang Y, et al. ISUOG Interim guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound Obstet Gynecol. 2020;55 (5):700-8.

Guidance for fetal medicine units (FMUs) in the evolving coronavirus (COVID-19) pandemic. Available at: documents/guidelines/2020-07-10-guidance-for-fetal-medicine-units.pdf. Accessed on 20 June 2020.

Safe practice in obstetric ultrasound and fetal medicine: COVID guidance. Available at: Accessed on 20 June 2020.

Deprest J, Choolani M, Chervenak F, Farmer D, Lagrou K, Lopriore E, et al. Fetal Diagnosis and therapy during the COVID-19 pandemic: guidance on behalf of the International fetal medicine and surgery. Fetal Diagn Ther. 2020;1-10.

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15.

Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest ct in diagnosis and management. AJR Am J Roentgenol. 2020;214(6):1280-6.

Ai T, Yang Z, Hou H, Zhann C, Chen C, Lv W, et al. Correlation of chest ct and rt-pcr testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296(2):E32-40.

Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics. 2007;27(6): 1705-22.

Drugs and lactation database (LactMed). Available at: 1398. Accessed on 20 June 2020.

Miller RW. Discussion: severe mental retardation and cancer among atomic bomb survivors exposed in utero. Teratology. 1999;59(4):234-5.

Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020;20(6):652-3.

Guidance for management of pregnant women in COVID-19 pandemic. Available at: https://www. Women_in_COVID -19_Pandemic_12042020.pdf. Accessed on 20 June 2020.

Inducing labour. Available at: https://www.nice. Accessed on 20 June 2020.

Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J, et al. Viral Shedding of COVID-19 in pregnant women. Available at: Accessed on 20 June 2020.

Liu D, Li L, Wu X, Zheng D, Wang J, Yang l, et al. Pregnancy and perinatal outcomes of women with coronavirus disease (covid-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020; 215(1):127-32.

Novel Coronavirus 2019 (COVID-19).Available at: Accessed on 20 June 2020.

Puopolo KM, Hudak ML, Kimberlin DW, Cummings JJ. Management of Infants Born to Mothers with COVID-19. Available at: 221157/pediatrics/management-infants-born-mothers-covid-19. Accessed on 20 June 2020.

Amatya S, Corr TE, Gandhi CK. Management of newborns exposed to mothers with confirmed or suspected COVID-19. J Perinatol. 2020;40:987-96.

Evaluation and management considerations for neonates at risk for coronavirus disease 2019 (COVID-19). Available from: coronavirus/2019-ncov/hcp/caring-for-newborns.html. Accessed on 20 June 2020.

Carvalho WB, Gibelli MABC, Krebs VLJ, Calil VMLT, Johnston C. Expert recommendations for the care of newborns of mothers with COVID-19. Clinics (Sao Paulo). 2020;75:e1932.

Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Available at: Accessed on 20 June 2020.

Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol. 2009;10(6):589-97.

Li JY, Duan XF, Wang LP, Xu YJ, Huang L, Zhang TF, et al. Selective depletion of regulatory T cell subsets by docetaxel treatment in patients with nonsmall cell lung cancer. J Immunol Res. 2014; 2014:286170.

Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearce RM, Fragkou PC, et al. Features of postoperative immune suppression are reversible with interferon gamma and independent of interleukin-6 pathways. Ann Surg. 2016;264(2):370-7.

Sica A, Massarotti M. Myeloid suppressor cells in cancer and autoimmunity. J Autoimmun. 2017;85: 117-25.

Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 0utbreak. Cancer Discov. 2020;10(6): 783-91.

Zhang J, Peng P, Li X, Zha YF, Zhang GN, Zhang Y, et al. Management strategies for patients with gynecological malignancies during the outbreak of COVID-19. Zhonghua Fu Chan Ke Za Zhi. 2020;55 (4):221-6.

Shen SC, Hung YC, Kung PT, Yang WH, Wang YH, Tsai WC. Factors involved in the delay of treatment initiation for cervical cancer patients: A nationwide population-based study. Medicine (Baltimore). 2016; 95(33):e4568.

Strohl AE, Feinglass JM, Shahabi S, Simon MA. Surgical wait time: A new health indicator in women with endometrial cancer. Gynecologic Oncology. 2016;141(3):511-5.

Liu Y, Zhang T, Wu Q, Jiao Y, Gong T, Ma X, et al. Relationship between initiation time of adjuvant chemotherapy and survival in ovarian cancer patients: a dose-response meta-analysis of cohort studies. Sci Rep. 2017;7(1):9461.

Eggermont AM, Steller EP, Sugarbaker PH. Laparotomy enhances intraperitoneal tumor growth and abrogates the antitumor effects of interleukin-2 and lymphokine-activated killer cells. Surgery. 1987; 102(1):71-8.

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.

Odor PM, Neun M, Bampoe S, Clark S, Heaton D, Patel A, et al. Anaesthesia and COVID-19: infection control. Br J Anaesth. 2020;125(1):16-24.

Ramirez PT, Chiva L, Eriksson AGZ, Frumovitz M, Fagotti A, Martin AG, et al. COVID-19 Global pandemic: options for management of gynecologic cancers. Int J Gynecol Cancer. 2020;30(5):561-3.

Burki TK. Cancer care in the time of COVID-19. Lancet Oncol. 2020;21(5):628.

BGCS framework for care of patients with gynaecological cancer during the COVID-19 pandemic. Available at: wp-content/uploads/2020/03/BGCS-covid-guidance-v1.-22.03.2020.pdf. Accessed on 20 June 2020.

Fader AN, Huh WK, Kesterson J, Pothuri B, Wethington S, Wright JD, et al. When to operate, hesitate and reintegrate: society of gynecologic oncology surgical considerations during the COVID-19 pandemic. Gynecol Oncol. 2020:158(2):236-43.

Coronavirus disease 2019 (COVID-19) - prevention & treatment. Available at: coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed on 20 June 2020.

Ueda M, Martins R, Hendrie PC, Crews JR, Wong TL, Jagels B, et al. Managing cancer care during the COVID-19 pandemic: agility and collaboration toward a common goal. J Natl Compr Canc Netw. 2020;1-4.

Telemedicine practice guidelines: enabling registered medical practitioners to provide healthcare using telemedicine. Available at: https://www.mohfw. Accessed on 20 June 2020.

Wenham C, Smith J, Morgan R. COVID-19: the gendered impacts of the outbreak. The Lancet. 2020;395(10227):846-8.

Modi Orders 3-Week total lockdown for all 1.3 billion Indians. Available at: https://www.nytimes. com/2020/03/24/world/asia/india-coronavirus-lockdown.html. Accessed on 20 June 2020.

Davies SE, Bennett B. A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. Int Aff .2016;92:1041-60.