Hope amidst the pandemic
By Dr. Dineshani Hettiarachchi Sirisena
A few weeks ago, Sri Lanka made it into the history books when a team of doctors, nurses, and other health staff successfully delivered four babies (quadruplets) from a Covid-19-positive mother via caesarean delivery. We spoke to De Soysa Hospital for Women consultant obstetrician and gynaecologist Dr. Diluk Senadheera who delivered the babies.
He mentioned that the expectant mother was under the care of a multidisciplinary team comprising consultant obstetrician and gynaecologist Dr. S.A. Ruwan Pathirana, consultant physician Dr. Priyankara Jayawardena, consultant anesthetists Dr. Saroja Jayasinghe and Dr. Harshini Liyanage, consultant microbiologist Dr. Sawani Athukorala, consultant haematologist Dr. Anoma Weerawardena, neonatal paediatrician Dr. Nalin Gamaathige, and De Soysa Hospital for Women Director Dr. Sagarika Kiriwandeniya.
Dr. Senadheera explained that the mother was admitted to the high-risk ward at the De Soysa Hospital when she was around 27 weeks, long showing symptoms of fever and difficulty in breathing. There are two wards at the hospital that cater to high-risk patients, namely wards 15 and eight. Pregnant women who become positive for Covid-19 are considered a priority group for healthcare services. They follow a Covid-19 risk assessment protocol before admission to these two wards.
If the pregnant lady has a significant contact history from a high-risk area, or shows at least one of the Covid-specific symptoms, she is then directly admitted to the high-risk ward, following which a PCR test is done. If the PCR test is negative, she will be sent to a normal ward. If she tests positive for Covid-19, she will be transferred to Dr. Neville Fernando Teaching Hospital, Homagama Base Hospital, or Mulleriyawa Base Hospital. If there are any complications, she will be kept at De Soysa Hospital until stable.
In this specific case, the lady was kept under watch at De Soysa Hospital since she developed complications. Dr. Senadheera went on to say that there were several medical challenges they had to face in addition to her carrying four babies. It was noticed that there was liver and kidney damage in the mother. Initially, there was no evidence that the liver derangement was due to the Covid-19 infection. However, as more global data surfaced, now it’s estimated that 30-53% of Covid-positive pregnant women can have liver involvement during their pregnancy.
She also had other complications such as the excessive breakdown of red blood cells (hemolysis) which led to her becoming anaemic and needing regular blood transfusions. Later, all these features were attributed to multi-organ damage due to immune-mediated viral infection and, in this case, due to a high viral load of Covid-19.
However, with the help of the multidisciplinary team, she went on to deliver four healthy babies (two girls and two boys) at 31 weeks. Usually, they would keep a quadruplet pregnancy until 34 weeks. However, in the face of the deteriorating maternal condition, they had to perform an emergency caesarean. The team delivered four babies whose weight ranged from 1.1 kg to 1.6 kg, and they are currently healthy and well.
Covid-19 and pregnancy
According to the Royal College of Obstetricians and Gynecologists (RCOG), pregnant women do not appear more likely to contract the infection than the general population. Most pregnant women who are infected with SARS-CoV-2 will experience only mild or moderate cold/flu-like symptoms. The most common symptoms of Covid-19 in pregnant women are fever (40%) and cough (39%). Less frequent symptoms are difficulty in breathing (dyspnea), body pains (myalgia), and loss of sense of taste and diarrhoea. However, there are always exceptions to the norm, hence pregnancy is considered in a moderate to high-risk category if complicated with Covid-19 infection.
Precautions are taken at the hospital
Dr. Senadheera stated that they stringently follow necessary precautions to avoid staff-to-staff, staff-to-patient, and patient-to-patient transmission at the ward setting. Each procedure has specific personal protective gear that protects the healthcare provider. This was attributed to their success in managing and avoiding Covid-19 transmission in the hospital setting. As such, they have admitted 137 Covid-19-positive pregnant women and have delivered 35 of them at De Soysa Hospital.
What should you do if you get Covid during pregnancy?
There are clear guidelines set forth by the Ministry of Health in case a pregnant woman is suspected to have Covid-19. Currently, all Covid-related pregnancies are managed at the hospital setting and they’re not sent to government quarantine centres. If their condition is stable, they will be sent to special Covid hospitals with obstetric facilities. If the lady is from a lockdown or isolated area, her care will be co-ordinated by the public health midwife who has a list of pregnant women in her locality. She will then contact the specific hospitals and arrange checkups such as the routine antenatal care visits and scans.
If someone who is attending the private sector tests positive, they will be transferred to the government sector where facilities are available. Currently, a Covid-19 PCR test must be done before elective surgeries, and in case of an emergency, a rapid antigen test will be performed.
Prevention
Pregnant women should follow the same recommendations as non-pregnant persons to avoid exposure to the virus. Women with an epidemiologic history of contact should be monitored and if there is a clinical suspicion, it’s always advisable to get tested. Pregnant healthcare workers have additional concerns and should be extra cautious, especially during higher-risk procedures (e.g. aerosol-generating procedures). Additionally, the psychological impact of Covid-19 should also be recognised and support must be offered as it’s a time of uncertainty. Many pregnant women have reported having moderate to severe anxiety.
Take-home message
It’s important to take precautions against getting infected by following health guidelines.
- Wash hands regularly and frequently with an alcohol-based hand rub or soap and water
- Wear a proper facemask
- Avoid anyone who is coughing and sneezing
- Avoid touching eyes, nose, and mouth
- Maintain social distancing and reduce general community exposure
- Early reporting and investigation of symptoms
- Prompt access to appropriate treatment and supportive measures if infected
Your doctors, midwives, and other healthcare workers care about you and your baby. They understand that you will feel worried. Take the opportunity to rest, eat well, and maintain your general and mental wellbeing, where possible. The medical staff ensures that even if you contract Covid-19 during pregnancy, there are guidelines and protocols set in place to minimise the risk to you and your baby. Pregnancy, birth, and parenting should be a happy time for mothers, fathers, and their families.
*The hospital has received prior consent from the mother and the family to share details of the birth with the media
I’m very happy they’re safe and healthy: Father
By Venessa Anthony
Speaking to The Sunday Morning Brunch, Gihan Chandrathilake, the father of the quadruplets, talked about his experience having four children during this time.
“I had seen the scan beforehand, so we knew we were having quadruplets. I was very afraid and worried about the health of our babies and my wife. After the delivery was completed successfully, I felt an immense amount of relief. I’m very happy that they’re safe and healthy.”
He also shared that his babies and wife are still hospitalised, although there are no complications that they have to watch out for at the moment. The last time he saw his kids was the day they were born, which was about two weeks ago. Noting that the hospital hasn’t permitted him to see them again as of yet, he said he should be allowed to see them in another two to three weeks’ time.
“I’m eagerly waiting to see my kids and wife again.”
The biggest challenge he will have to face, he said, is in terms of financial management. Bringing up four kids is no easy task, especially in this day and age. He told us that he will face whatever challenges that may come as they come, while ensuring the kids are brought up living a normal life.
Main image by Janko Ferlič on Unsplash
