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Your CKD patient asks- Is it OK to plan #Pregnancy amidst #COVIDPandemic? What's your take? #askrenal
Tight rope walk of pregnancy & CKD is worse now
Check out our review on COVID19 pandemic and pregnancy in kidney disease https://www.sciencedirect.com/science/article/pii/S154855952030121X
Thread on salient features 1/
Tight rope walk of pregnancy & CKD is worse now
Check out our review on COVID19 pandemic and pregnancy in kidney disease https://www.sciencedirect.com/science/article/pii/S154855952030121X
Thread on salient features 1/
2/
R pregnant women more susceptible?
Does pregnancy affects maternal course of #COVID?
Does #COVID affect #pregnancy outcomes?
+
Antenatal care during the #Pandemic
Management of #COVID in mother
Psychological impact of #COVID19
Special considerations in CKD
R pregnant women more susceptible? Does pregnancy affects maternal course of #COVID?Does #COVID affect #pregnancy outcomes?+Antenatal care during the #PandemicManagement of #COVID in motherPsychological impact of #COVID19 Special considerations in CKD
3/
More clinic visits - 
exposure
changes in resp & immunological physiology-susceptibility to viral resp infections
Yet, no data till now to show #COVID risk
But, We don't know it all
So, take all precautions to
exposure
More clinic visits - exposurechanges in resp & immunological physiology-susceptibility to viral resp infectionsYet, no data till now to show
#COVID riskBut, We don't know it all
So, take all precautions to
exposure
4/
Early reports= No difference in maternal course of #covid19 in pregnancy.
But check this recent @CDCgov report of >90,000
High ICU adm
Mech Ventilation in pregnant Vs non-pregnant
bottom line- Monitor closely for worsening of disease in pregnancy
https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm
Early reports= No difference in maternal course of #covid19 in pregnancy.
But check this recent @CDCgov report of >90,000
High ICU admMech Ventilation in pregnant Vs non-pregnantbottom line- Monitor closely for worsening of disease in pregnancy
https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm
5/
#COVID19 is associated with
Preterm Births
Cesarean sections
No higher neonatal deaths
but association ≠ causation.
And this association is multifactorial https://pubmed.ncbi.nlm.nih.gov/32516273/
#COVID19 is associated with
Preterm BirthsCesarean sectionsNo higher neonatal deaths
but association ≠ causation.
And this association is multifactorial https://pubmed.ncbi.nlm.nih.gov/32516273/
6/
Do NOT compromise on antenatal care during #COVID19
Telemedicine
Home monitoring (maternal/fetal)
FDA has approved monitoring devices for the pandemic
Self-monitoring of symptoms
Reduce exposure https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-non-invasive-fetal-and-maternal-monitoring-devices-used-support-patient
Do NOT compromise on antenatal care during #COVID19
Telemedicine Home monitoring (maternal/fetal)FDA has approved monitoring devices for the pandemic
Self-monitoring of symptomsReduce exposure https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-non-invasive-fetal-and-maternal-monitoring-devices-used-support-patient
7/
Pregnant woman with #COVID19
Ensure hydration
Optimum Oxygenation for +
Judicious use of imaging
Teratogenicity of drugs
Drugs with Vd - high dose
VTE prophylaxis
exposure to #HCWs during delivery 
Pregnant woman with #COVID19
Ensure hydrationOptimum Oxygenation for +Judicious use of imagingTeratogenicity of drugsDrugs with Vd - high doseVTE prophylaxisexposure to #HCWs during delivery
8/
NOT all AKI in these pts is due to #COVID -Don't miss other causes of AKI in pregnancy
Lower creatinine cutoff for diagnosis AKI in pregnancy
W/f prerenal AKI -loss [fever+tachypnea]
Cautious use of diuretics
HD/CRRT-avoid hypotension to preserve placental perfusion
![8/NOT all AKI in these pts is due to #COVID -Don't miss other causes of AKI in pregnancyLower creatinine cutoff for diagnosis AKI in pregnancyW/f prerenal AKI -loss [fever+tachypnea]Cautious use of diureticsHD/CRRT-avoid hypotension to preserve placental perfusion](https://pbs.twimg.com/media/EfEMwHgU0AA5zdM.jpg "8/NOT all AKI in these pts is due to #COVID -Don't miss other causes of AKI in pregnancyLower creatinine cutoff for diagnosis AKI in pregnancyW/f prerenal AKI -loss [fever+tachypnea]Cautious use of diureticsHD/CRRT-avoid hypotension to preserve placental perfusion")
NOT all AKI in these pts is due to #COVID -Don't miss other causes of AKI in pregnancy
Lower creatinine cutoff for diagnosis AKI in pregnancyW/f prerenal AKI -loss [fever+tachypnea]Cautious use of diureticsHD/CRRT-avoid hypotension to preserve placental perfusion
9/
Pregnant CKD patient with #COVID19
High risk for maternal and fetal complications
Close home monitoring + teleconferencing
May require intensive RRT till delivery- scarcity of HD slots in #Pandemic- anticipate and prepare in advance
Multidisciplinary team approach
Pregnant CKD patient with #COVID19
High risk for maternal and fetal complicationsClose home monitoring + teleconferencingMay require intensive RRT till delivery- scarcity of HD slots in #Pandemic- anticipate and prepare in advanceMultidisciplinary team approach
10/
Pregnant kidney transplant recipient with #COVID19
High-risk group require close monitoring
Judicious tapering of immunosuppression
Drug interactions with CNI
Therapeutic drug monitoring especially in pts with diarrhoea
Pregnant kidney transplant recipient with #COVID19
High-risk group require close monitoringJudicious tapering of immunosuppressionDrug interactions with CNITherapeutic drug monitoring especially in pts with diarrhoea
11/
A neonate born to a mom with #COVID19
Consider high-risk contact- isolate
Swab for PCR and antibody testing within 24 hrs
Breastfeeding can continue with surface and hand hygiene
A neonate born to a mom with #COVID19
Consider high-risk contact- isolateSwab for PCR and antibody testing within 24 hrsBreastfeeding can continue with surface and hand hygiene
12/
Lastly
Don't underestimate the psychological impact of #COVID on mother
She may feel secluded depression & anxiety
Domestic violence & discrimination
Financial hardships
Should ensure adq screening and Rx either in person or virtually https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204688/#
Lastly
Don't underestimate the psychological impact of #COVID on mother
She may feel secluded depression & anxietyDomestic violence & discriminationFinancial hardshipsShould ensure adq screening and Rx either in person or virtually https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204688/#
13/
A multidisciplinary team approach will lead to successful #pregnancy outcomes in Women with #CKD even during the #CovidPandemic
Thanks to @silvishah and @Nephro_Sparks for the opportunity to compile this review
A multidisciplinary team approach will lead to successful #pregnancy outcomes in Women with #CKD even during the #CovidPandemic
Thanks to @silvishah and @Nephro_Sparks for the opportunity to compile this review
