When You Should Go To The ER If You're Pregnant And Have COVID

Pregnancy increases risk for a severe COVID infection. Watch for these warning signs.
Doctors share the best advice for monitoring COVID symptoms if you're infected while pregnant.
aywan88 via Getty Images
Doctors share the best advice for monitoring COVID symptoms if you're infected while pregnant.

After seeing two pink lines on a pregnancy test eight months ago, I’ve been excitedly preparing for the arrival of my new baby. But when I tested positive on a different kind of test in my third trimester, my heart sank. At 33 weeks pregnant, I was COVID positive — and absolutely miserable.

Pregnancy makes life more difficult for many people, including me. All-day fatigue turns into terrible insomnia at night. Intense cravings lead to heartburn. Pressure from a growing baby causes aches and pains everywhere. So, I was more than a little nervous about how COVID would affect me.

This anxiety was not unfounded. According to the Centers for Disease Control and Prevention, pregnant and recently pregnant people are more likely to get severely ill from COVID-19 and more likely to need hospitalization, intensive care or a ventilator to help them breathe.

Those with COVID are also more likely to experience preterm birth, stillbirth and other pregnancy complications. One study found that pregnant women who are Hispanic or Black may be disproportionately affected by the SARS-CoV-2 infection (the virus that causes COVID) during pregnancy.

The most important thing that pregnant people who test positive for COVID can do is stay calm. Then, read the advice from doctors on what to do next.

The key signs that you should go to the ER

The CDC recommends calling your health care professional (if you’re pregnant, that would be your OB-GYN or midwife) within 24 hours of testing positive or showing symptoms of COVID-19.

Then, go to the ER if you have any of these emergency warning signs of COVID:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
  • Any other symptoms your medical provider recommends watching for

Dr. Greg Marchand, a board-certified OB-GYN based in Mesa, Arizona, recommends seeking medical attention if you have a fever that won’t go away for longer than 24 hours, even while taking Tylenol. (NSAIDs like ibuprofen should be avoided in pregnancy.)

Additionally, “head to the emergency room if you’re having difficulty breathing or if you’re unable to keep down any liquids for more than four hours,” Marchand advised. “If you’re more than 24 weeks pregnant, you will also want to go in if you don’t feel the baby move.”

Dr. Mobola Kukoyi, a board-certified emergency and public health physician based in Illinois, listed decreased fetal movement, decreased urination, chest pain, trouble breathing, persistent nausea and vomiting as red flags that signal a trip to the emergency room. Other warning signs could include extreme swelling of your hands or face, vaginal bleeding or discharge, or severe redness or pain in your arm.

How to differentiate pregnancy-related shortness of breath from a COVID symptom

Shortness of breath is common during pregnancy. In the first trimester, this is due to an increase in the hormone progesterone. Later pregnancy, it’s caused by the baby getting bigger and pressing on the diaphragm, making it hard for the lungs to fully expand.

However, if you feel a sudden onset of shortness of breath or trouble breathing after testing positive for COVID-19, it could be a sign of something more dangerous.

“You should go to the emergency room if you have signs such as chest pain or trouble breathing,” Kukoyi said. “If you are having respiratory symptoms, it is recommended that you monitor your home oxygen levels with a pulse oximeter and go to the ER if you consistently have levels below 92%.”

It’s important to monitor your breathing, especially during pregnancy, to watch for things like “severe lung infection leading to respiratory distress,” which can be “riskier in pregnancy given the additional demand on the body,” according to Kukoyi.

“In addition, pregnancy can cause a hypercoagulable state, meaning the blood can become more prone to forming clots in the lungs and legs,” Kukoyi said. “As COVID can also cause clots, this can theoretically increase risks in pregnancy.

Signs of a blood clot in the lung (pulmonary embolism) include severe chest pain that worsens with breathing, shortness of breath, or low oxygen levels. Signs of a blood clot in the leg (deep vein thrombosis) could be unilateral leg swelling (one bigger than the other), pain and swelling of the leg, especially the calf.

Health care workers can assess your symptoms and see if they're a risk with your pregnancy.
NoSystem images via Getty Images
Health care workers can assess your symptoms and see if they're a risk with your pregnancy.

What ER physicians can do for someone with COVID who is pregnant

When I was sick with COVID during pregnancy, my OB-GYN recommended I go to the emergency room, as I was maintaining a 101-degree fever even after taking fever-reducing medication. The reason? To make sure the baby is staying oxygenated.

“The baby gets oxygenated as long as the mother is adequately oxygenated,” Kukoyi explained. “In the ER, we can check the baby’s heart rate to make sure it remains within normal range, as this is usually the first indication of an adverse event. Sometimes, your OB-GYN may be able to perform a more extensive fetal monitoring in the ER for a few hours.”

Your doctor will probably also want to make sure your fever doesn’t get too high, as “high-grade fevers may be associated with birth defects, especially in early pregnancy,” Kukoyi said.

How pregnant people can ease less severe COVID symptoms

Luckily, transmission of COVID from a pregnant person to a fetus is rare. My emergency room visit showed my baby had healthy oxygen levels and movement — he wasn’t affected at all by how miserable I was.

For pregnant people suffering with COVID symptoms, there are a few ways to ease your discomfort.

“Taking Tylenol, staying hydrated with a minimum of 64 ounces of water a day, and getting plenty of rest will be helpful,” Kukoyi said. She also recommended taking a warm bath, as long as it’s not too hot, and using heat packs for muscle pain. “For cold/cough symptoms, use of a humidifier can help,” she added. “You can also discuss what cough medicines can be used to relieve symptoms with your doctor.”

“Hydration is important and so is vitamin C intake,” Marchand explained. He also recommends monitoring the baby’s movement and prioritizing rest.

COVID vaccination is crucial for people who are pregnant

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend that all pregnant women be vaccinated against COVID-19. This is due in part to the evidence of the vaccines’ safe and effective use in pregnant people due to the tens of thousands of reporting individuals. My OB-GYN explained that being vaccinated is why I had a relatively mild case — only experiencing symptoms for about two days before I felt better.

Getting vaccinated will also help your unborn baby. A recent study published in JAMA found that the majority of infants born to COVID-vaccinated mothers still had persistent antibodies at 6 months old, compared with infants born to mothers with a COVID infection.

If you are pregnant with a COVID infection, or feel something is off, don’t hesitate to call your doctor or visit an emergency room to get checked. At the very least, it will give you peace of mind that everything with the baby is OK.

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