A woman from Mumbai, in her late 20s, has become the first to have experienced a miscarriage due to COVID-19 in India.

On August 22, a paper appeared in medRxiv, a preprint server for health sciences research. It mentioned abouta woman in her late 20s whose fetus had died in the uterus. The woman was in her first trimester. She worked as a security guard in a government hospital in Mumbai.

She had come in contact with a COVID-19 positive case when she was eight weeks pregnant. While she had no symptoms, a nasopharyngeal test was done which showed positive result for the virus.She was, therefore, admitted to institutional isolation.

About four weeks later, a second test was conducted which revealed no trace of the virus in her nasopharyngeal tract. She was healthy; however, a week later, at 13 weeks of pregnancy, a routine ultrasound test revealed that the fetus had died.

Dr Prajakta Shende of the gynaecology department of ESIS hospital stated that they ordered more tests. The fetus had suffered from a condition known as ‘hydrops fetalis’, suspected to have been caused due to inflammation.

Dr Deepak Modi, a placenta biologist at NIRRH, explained that the woman had tested negative for COVID-19 in the second test, which suggested that there was no trace of the virus her throat and nasal tract. However, the infection may have travelled towards the womb.

When the placenta, amniotic fluid from the gestational sac, and the fetal membrane were subjected to testing, the placenta and amniotic fluid showed active SARS-CoV-2 virus replication. This came as a surprise as it had already been more than 5 weeks since the woman contracted the infection.

Doctors came to the conclusion that placental infection due to COVID-19 resulted in inflammation and death of the fetus.

There is scarcity of information on COVID-19-related complications in pregnancy, and limited research exists on the way the novel coronavirus affects the fetus.

ICMR-National Institute for Research in Reproductive Health (NIRRH) had noted in some early studies that the placenta may act as a reservoir for SARS-CoV-2.

A similar case of miscarriage was reported from Switzerland in Marchin a 28-year-old woman. The woman was obese and had COVID-19 infection. She gave birth to a still born child in the second trimester.

The placenta is known to act as a barrier that protects the fetus from external infections. However, some studies have shown that it may act as a reservoir for the coronavirus, facilitating its replication.

Investigators from ICMR-NIRRH and BSSE, IISc, have noted that the placenta is abundant in ‘S protein proteases’ and ‘ACE2’ receptors during the first, second, and third trimesters, which act as a portal of entry for SARS-CoV-2.

Around 17 studies involving 93 COVID-19 infected pregnant women; the placenta has tested positive for the virus in around 12% of cases.

Although vertical transmission is not very common, but it has been noted globally. The US Centres for Disease Control and Prevention (CDC) has noted that pregnant women infected with COVID-19 have a greater risk of requiring hospitalization and intensive care.

While no similar data are available for India, anecdotal reports from treating doctors state that most COVID-19 infected women are asymptomatic or mildly symptomatic. Nair Hospital in Mumbai has tracked deliveries in 400 infected women; four women died due to other medical conditions, and none recorded vertical transmission. In Wadia Hospital, there were three cases of vertical transmission out of more than 200 deliveries.

In order to better understand placental infection in COVID-19, Wadia Hospital, along with NIRRH, is going to conduct tests on 100 pregnant women to check whether their placenta has coronavirus after delivery.

ICMR-NIRRH have also collaborated with the Maharashtra government and 19 medical colleges to develop a registry of COVID-19 infected pregnant women, and of their post-partum period. Until August 20, more than 1,000 women had been registered.

Investigators will study how the coronavirus affects pregnancy, newborns, women in the post-partum period, and the outcome of the infection in mother and child. The registry will have a role in framing policy on maternal child care during the pandemic… (The Indian Express)

Source: The Indian Express