Managing COVID-19 amongst pregnant women in Cox’s Bazar
Disproportionate impact of the pandemic on women of reproductive age, particularly pregnant mothers and newborns has been a major concern. Asthe pandemic advanced in Cox’s Bazar, currently the world’s largest camp for displaced persons, one of the major challenges was how to safeguard interests of vulnerable groups, including pregnant women.
Against this background, since April 2020, Yale university has been supporting a large team of clinicians at the Cox’s Bazar, with surge management, coordination, clinical standards of care and several weekly clinical case conferences. These were held for partner organizations such as International Organization for Migration( IOM) , Médecins Sans Frontières (MSF) and the Intensivists in the local Sadar District Hospital. The hospital was fitted out with equipment and staff with support from the United Nations High Commissioner for Refugees (UNHCR) to serve both host and refugee communities.
In these weekly clinical conferences conducted with the support of Yale university , discussions between health care personnel from local Sadar hospital and UNHCR staff focused on guidelines, new information and best practices in patient management by specialists from Yale and Intensivists (Australian specialists from Darwin and Melbourne); and nursing and rehabilitation specialists (from AUSMAT) who worked closely with the WHO Medical Officer at the Cox’s Bazar and WHO staff who provided technical support remotely.
Need for expert guidance on possible complications
In these conferences, case studies were taken up (including one full case and two summaries of critical COVID-19 cases in pregnant women seen in the last few months) for discussion with experts. In one of the sessions, they took up specific aspects related to a pregnant mother’s affliction with the Acute Respiratory Distress Syndrome and how she delivered emergently at term by C-section and developed a likely septic shock from a wound infection. This prompted the need for more detailed brainstorming among international experts on how to manage severe and critical COVID-19 cases in pregnancy for the benefit of local doctors in Bangladesh.
The head of the local intensive care unit team reiterated the need for further technical guidance to treat critical cases in the near future and requested support for the same. Cox’s Bazar requested experts including those from WHO and the WHO’s South East Asia region who would be willing to give a talk and answer questions on managing respiratory related COVID-19 complications during pregnancy as per available evidence and WHO guidelines.
Important outcomes from focused discussions
A discussion took place on 22 September 2021 with international experts providing guidance to Cox’s Bazar on future management of similar cases. The audience comprised of clinicians, nurses and other allied health service providers. WHO SEARO was represented by the Infectious Hazard Management (IHM) unit which is responsible for clinical management of COVID-19 in the health operations pillar and Family Health Gender Life Course (FGL) , the responsible technical unit for maternal care. FGL coordinated the services of Professor Neerja Bhatla, director of the WHO Collaboration Centre at the All India Institute of Medical Sciences (AIIMS) and brought her in as a regional expert. As an outcome of the discussion and meeting, the need for regional standard operating procedures (SoPs) on clinical management of pregnancy related complications for COVID-19 patients was emphasized. As next steps, FGL/SEARO would be coordinating work in this area, with Professor Neerja Bhatla
