Thread by @FionaMattatall

Today's Department Grand Rounds: an update on COVID-19 in pregnancy.

Excellent work again from our team of local experts.

Thought some of you might be interested so here I made a long thread...

#COVID19 #vaccine #pregnancy #covid19AB

Cases of COVID-19 in pregnancy across Canada: where we are as of today October 1, 2021 👇🏻

As you can see we are hit hardest in AB/NWT (37% of all cases in the country)

Over 1100 have been in Calgary alone.

#covid19AB #pregnancy #yyc

Focussing in on Alberta cases of COVID-19 in pregnancy through the whole pandemic, the peak so far was Wave 3 however Wave 4 is proving challenging with steady numbers - over 50 new cases per day since mid August 👇🏻

For hospitalization for pregnant patients with COVID-19 in Alberta, there are noticeable differences over time.

Wave 4:
- higher chances of ED visits (both number of patients coming into ED and number of times each needs to come in)
- triple the need for ICU admission

Every Alberta pregnant patient who needed ICU admission for COVID-19 was not fully vaccinated.

I hope the message has reached everyone by now, but in case you weren't paying attention...

VACCINATION PROTECTS AGAINST ICU ADMISSION!

Looking at details on deliveries for Alberta pregnant patients with COVID-19, we are seeing higher rates of preterm birth and need for Caesarean section in Wave 4 👇🏻

A reminder to everyone of the @CDCgov advisory that came out this week 👇🏻

Tl;dr ... Planning pregnancy or pregnant now? Get vaccinated!

Data out of the USA seeing similar trends to ours (125k cases, 22k hospitalized, 161 deaths; 4th wave worst)

emergency.cdc.gov/han/2021/han00…

Take home messages for overall approach to care of the pregnant patient with COVID-19... heads up, this is where the thread gets more technical

Use of steroids for treatment of COVID-19 in pregnancy 👇🏻 (remember that for dexamethasone for fetal lung maturity takes 4 doses!)

Use of Tocilizumab (interleukin-6 receptor monoclonal antibody) for treatment of COVID-19 in pregnancy (fortunately this drug had previously been studied in pregnant patients with arthritis) 👇🏻

Remember that pregnancy is a risk factor for VTE and COVID-19 plus hospitalization adds to that risk.

Consider both who should be offered chemoprophylaxis.

But keep in mind these patients may require urgent Cesarean section so weight based prophylactic dosing likely best.

More take home messages:
- delivery indicated for critically ill (not just infected or intubated)
- as with other conditions, as you approach term the threshold for deliver is lower as the risk of preterm birth to the neonate is lower

More considerations for timing of delivery... it truly takes a village (Ob/MFM, IM/ObIM, ICU, Neo, Anaesth) 👇🏻

#COVID19 #pregnancy

- Small studies on COVID-19 and pregnancy are guiding treatment with therapeutics

- Pregnant patients can be positioned prone

- NM blockade and sedatives may result in neonatal effects

- We have not used ECMO in pregnant COVID-19 patients yet in Calgary

#GetVaccinated

Now onto how to support those pregnant patients whose COVID-19 infection is not severe enough to be hospitalized...

Remember the @DrStephanieCoo1 Tweet a few weeks back asking for O2 monitors? This is what it is all about 👇🏻

We have a home support program in #yyc!

Want some good news?

COVID-19 vaccination when breastfeeding safe, well tolerated, and the IgA antibodies cross readily into the breastmilk, protecting the infant!

jamanetwork.com/journals/jama/… #breastfeeding #CovidVaccine

Want some more good news?

COVID-19 vaccine does not increase risk of miscarriage!
Tl;dr ... adjusted odds ratio, 1.02; 95% CI, 0.96-1.08

jamanetwork.com/journals/jama/… #pregnancy #CovidVaccine

@AHS_media have a comprehensive and up to date online resource that answers your questions on COVID-19 and pregnancy, birth, postpartum, breastfeeding!

Check it out 👇🏻

albertahealthservices.ca/assets/info/pp…

Some points that came up in the Q&A:
- NSTs for patients in ICU (not CEFM)
- Wave 4 patients who require hospitalization don't have other risk factors as we saw previously
- no data on long covid for pregnant patients
- we have seen patients in every trimester need ICU stay

And it wouldn't be a Calgary ObGyn Grand Rounds without @DrJenGunter being quoted...

Another kickass informative empowering article this week: vajenda.substack.com/p/how-can-we-b…

And with that, I am finished my longest Twitter thread ever...

Off to work and will leave you with a GIF (because I cannot leave you without a GIF 😉)