Dr Lakshmi Rathna Marakani - Talks about COVID-19 and Healthcare

Dr Lakshmi Rathna Marakani, Divisional Director NICE Hospital for New Born, Women & Children, and Senior consultant Apollo Craddle talks about gynaecology issues, treatments and protocols of the department amid the pandemic. Dr Lakshmi is also a Credentialed Menopause Practitioner, Laparoscopy surgeon and had advanced ultrasound colposcopy training from Sheffield U.K. Throughout her years of experience, she has presented several papers at National and International conferences. Hear it from the expert. 

How much has the gynaecology department been affected due to pandemic in India, and what is the scenario?
Yes, this new infection we know little about has affected a lot in certain ways. As this is a new infection, in case of pregnant women, we examine them and do the deliveries and required surgeries. We explain the basic measures to be taken when they come to the hospital because of the droplet method of spread of this COVID infection. Besides pregnant women, people with other gynaecology problems have been advised to stay indoors and consult the doctor from home, until necessary. The deserved cases would be coming for needed physical examination. At present, the risk to our patients is similar to the general population, but we need to be careful with high-risk individuals. 80 % of women with COVID infection will experience mild disease, 10% have a severe infection, and around 5% are in a critical state. Still, we have to wait to see the true effect.

What are the guidelines or protocols followed by the gynaecology department to keep the patients and doctors safe?
Until and unless there is an antepartum complication, we would like the patients to do online consultation where their reports can be shared. We at the hospital take all the measures like, when a patient comes, staff will see the thermal temperature, at the entrance, we guide them to wash their hands for 20-40 seconds with soap solution, take the personal and family history, we will restrict attendant coming in, we see that they wear the mask, we keep a chair 3-4 feet away from where we are sitting. For the patient’s safety- we wear our masks, caps, face shield and we change into hospital wear, after examining we sanitise the bed before the next patient comes, for surgeries we wear PPE kits with shoe covers. We also recommend all the pregnant women to go for COVID swab tests a few days before the deliveries, which is good for them and their newborn babies.

If a woman gets COVID-19 during her pregnancy period, will it affect the mother and the baby?
Antepartum complications and vertical transmission need more data to come to a conclusion. Worldwide there were few reports on this issue. The most important factor is we have to identify high-risk pregnant women, e.g. high blood pressure, high blood sugars in pregnancy, asthma, chronic heart disease, chronic Liver disease, blood dyscrasias, chronic kidney problems, post organ transplantation, malignancies, HIV affected pregnant women, people on Immunosuppressive medications. A systematic review of 33 studies all over the world involving 385 patients with COVID-19 was done there were 15.2% preterm deliveries, mostly Iatrogenic because of severe infection in mother. Other possible antepartum complications can be miscarriages severe oligohydramnios and IUGR. In WUHAN they reported 3 cases of intrapartum transmission. We need to check about Cross-contamination too as every person who is attending the delivery, and newborn care were not tested. So vertical transmission too is not yet confirmed.

Have any gynaecology surgeries been postponed due to COVID-19, and what is the status of such operations?
As far as I am concerned for non-critical cases with gynaec problems, it is the better option to try a medical treatment to its fullest extent and get benefitted. Some of them are seeing good results and happy for getting avoided the unnecessary surgeries. As a precaution we are advising them to have an elective surgery at a later date so that unnecessary hospitalisation is avoided which is good for the patient and in a larger platform hospital beds will be available for needed cases.

COVID-19 is not just affecting our body but mind too. There is panic and anxiety for everyone. What are your views and what measures or practices do you suggest to the ones who are pregnant?
I would firstly suggest anyone to not plan pregnancy at this time of uncertainty. If already pregnant, it’s important to not panic as we can overcome this with cooperation. Doctors will counsel them, but they must follow all general precautions including social distancing, hygiene and a good diet with Vitamin C and Vitamin D included. They can attend the hospital for their checkups at important stages of pregnancy advised by the doctor. In case of my patients, I first talk to them about the current scenario of COVID-19 infection and inform them about its complications if it gets serious and that there is no definite treatment as such.

There are no definite evidence-based guidelines for pregnant women regarding the evaluation and management of COVID-19. There is very limited data on them. As per the guidelines, every patient must give correct personal and family history to the treating doctor, including anyone with COVID symptoms, tests and any travel history. Secondly, they should strictly follow all the measures of personal care that is frequent hand washing, wearing a triple-layered mask, and following physical distancing of 3-6 feet. In case of feeding mothers, who are the primary source for infection in newborn and neonates; they must always wear a mask while breastfeeding their children, they must avoid unnecessary exposure to hospitals and public places, they must follow the guidelines of taking high protein diet, 1000 mg of vitamin c, weekly vitamin D 60000 units and a multivitamin containing zinc and other micronutrients.     - Srivalli