# COVID-19 in Pregnancy > COVID-19 in pregnancy for FMGE Obstetrics: risks by trimester, testing, steroids, thromboprophylaxis, vaccination and delivery timing. - Canonical URL: https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/covid-pregnancy-fmge - Exam / course: FMGE · Subject: Obstetrics and Gynaecology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "COVID-19 in Pregnancy", PrepElephant, https://prepelephant.com/topics/fmge/obstetrics-and-gynaecology/covid-pregnancy-fmge ## Direct answer COVID-19 in pregnancy runs a similar course to the non-pregnant illness but the risk of severe disease, intensive care admission and mechanical ventilation is higher, especially in the third trimester, and pregnancy itself is not a reason to defer vaccination or standard treatment. Management rests on the recognised pillars: hypoxaemic patients need awake proning and supplemental oxygen to maintain saturation above 94 per cent (90-94 in stable cases), corticosteroids — dexamethasone 6 mg daily for ten days — are indicated for the mother's respiratory illness, while fetal lung maturity keeps the obstetric default of intramuscular betamethasone or dexamethasone, and prophylactic low molecular weight heparin is given to hospitalised pregnant women because pregnancy and infection stack thromboembolism risk. Delivery timing follows obstetric indications, not the infection; maternal stabilisation precedes any caesarean. ## What you must remember - **Risk profile:** the third trimester carries the highest risk of severe disease; coexisting obesity, diabetes, hypertension and anaemia — all common in Indian antenatal populations — amplify it further. - **Investigation triad:** nasopharyngeal RT-PCR (or rapid antigen where delayed), chest imaging when indicated (a shielded chest radiograph is safe), and inflammatory markers (CRP, ferritin, LDH, D-dimer) for severity stratification. - **Steroid rule:** dexamethasone 6 mg once daily for up to 10 days for the mother who needs oxygen; when fetal maturity is also indicated, the standard obstetric protocol applies — intramuscular betamethasone 12 mg two doses 24 hours apart or dexamethasone 6 mg four doses 12 hours apart — never withheld because of COVID-19. - **Thromboprophylaxis:** prophylactic enoxaparin 40 mg subcutaneous daily for hospitalised pregnant women unless bleeding risk forbids it, commonly continued for 10-14 days post-discharge per institutional practice. - **Oxygen and proning:** target saturation 94 per cent or more; awake self-proning improves oxygenation in responsive hypoxaemia and costs nothing. - **Antivirals:** remdesivir and nirmatrelvir-ritonavir are used in pregnancy for qualifying risk categories per current guidance when benefits outweigh risks — neither is absolutely contraindicated. - **Delivery decisions:** COVID-19 alone is not an indication for caesarean section or for preterm delivery; vaginal delivery is preferred with the usual precautions, and delaying delivery by 48 hours after maternal stabilisation is reasonable where feasible — deferred cord clamping and skin-to-skin are permitted for well babies. - **Vaccination:** COVID-19 vaccines (including inactivated and mRNA platforms) are recommended in pregnancy in India; none is contraindicated, and the Government of India guidance permits vaccination at any stage of gestation. ## Managing a third-trimester admission Picture a 29-year-old at 34 weeks, body mass index 32, febrile with cough and saturation 92 per cent on room air. She is admitted, proned intermittently, given oxygen by face mask, enoxaparin 40 mg subcutaneously daily, and hourly saturation monitoring. Drift to 89 per cent despite proning moves her to high-flow oxygen and dexamethasone 6 mg daily — which conveniently serves fetal lung maturity if delivery becomes unavoidable. The fetus is monitored twice daily; antenatal corticosteroids are not "extra" here because the maternal indication already covers them. Labour begins on day 5. Delivery follows normal obstetric practice in full protective equipment: vaginal delivery is the default, caesarean only for obstetric reasons or refractory hypoxaemia. A well neonate needs no separation — rooming-in with masking and hand hygiene, direct breastfeeding encouraged, since the virus is not transmitted through breast milk in meaningful titre. Postpartum she continues enoxaparin and receives contraception counselling before discharge. ## Where students slip The recurring confusion is between the two steroid purposes. Dexamethasone 6 mg daily for ten days treats the mother's lungs (RECOVERY trial logic), while the antenatal corticosteroid course (betamethasone 12 mg twice or dexamethasone 6 mg four times intramuscularly) matures fetal lungs before a planned preterm birth — mixing the doses across questions is the commonest mark-loser. Second is the reflex caesarean: the exam answer is that COVID-19 by itself does not dictate the route of delivery. Third, candidates overstate vertical transmission — transplacental spread is rare; the practical newborn risks are contact and droplet, answered by masking and hygiene rather than separation. And in a viva: pregnancy was excluded from early vaccine trials, yet subsequent safety data and Government of India/FOGSI positions support vaccination in pregnancy. ## Frequently asked questions ### Is caesarean section indicated in a pregnant woman with COVID-19? No — mode of delivery follows standard obstetric indications; caesarean is reserved for obstetric reasons or severe refractory maternal respiratory compromise. ### Which corticosteroid regimen is used when the mother needs oxygen? Dexamethasone 6 mg once daily for up to ten days; if preterm delivery is anticipated, antenatal betamethasone 12 mg intramuscularly 24 hours apart fulfils fetal lung maturity. ### Should pregnant women with COVID-19 receive thromboprophylaxis? Hospitalised pregnant women receive prophylactic low molecular weight heparin such as enoxaparin 40 mg subcutaneous daily unless contraindicated, often continued briefly after discharge per local protocol. ### Can a mother with COVID-19 breastfeed? Yes — breast milk is not a meaningful transmission route; mothers should mask, sanitise hands, and room-in with a well newborn per current guidance. ### Are COVID-19 vaccines safe in pregnancy? Yes — vaccination is recommended during pregnancy in India at any gestation, as neither platform in use carries a pregnancy-specific contraindication, and severe disease risk in pregnancy is real.