Guidance for Management of Pregnant Women in COVID-19 Pandemic

Effect of COVID-19 on Pregnancy

• Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19.
• Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery.
• In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.
• Pregnant women with heart disease are at highest risk (congenital or acquired).
• The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact

Transmission

• With regard to vertical transmission (transmission from mother to baby antenatally or intrapartum), emerging evidence now suggests that vertical transmission is probable, although the proportion of pregnancies affectedand the significance to the neonate has yet to be determined.
• At present, there are no recorded cases of vaginal secretions being tested positive for COVID-19.
• At present, there are no recorded cases of breast milk being tested positive for COVID-19.

Effect on Foetus

• There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19.
• There is no evidence currently that the virus is teratogenic. Longterm data is awaited.
• COVID-19 infection is currently not an indication for Medical Termination of Pregnancy.

General Guidelines for Obstetric Health Care Providers

• Ob-gyns and other health care practitioners should contact their local and/or state health department for guidance on testing persons under investigationand should follow the national protocol.
• Health care practitioners shouldimmediatelynotify infection control personnel at their health care facility and their local or state health department in the event of a PUI for COVID-19.
• A registry for all women admitted to with confirmed COVID-19 infection in pregnancy should be maintained. Maternal and neonatal records including outcome should be completed in detail and preserved for analysis in future.
• Health care providers should create a plan to address the possibility of a decreased health care workforce, potential shortage of personal protective equipment, limited isolation rooms, and should maximize the use of telehealth across as many aspects of prenatal care as possible.
• Each facility should consider their appropriate space and staffing needs to prevent transmission of the virus that causes COVID-19.
• Pregnant women should be advised to increase their social distancing to reduce the risk of infectionand practice hand hygiene.
• Health care practitioners should promptly notify infection control personnel at their facility of the anticipated arrival of a pregnant patient who has confirmed COVID-19 or is a PUIso that infection control measures can be kept in place.
• Intrapartum services should be provided in a way that is safe, with reference to minimum staffing requirements and the ability to provide emergency obstetric, anaesthetic and neonatal care where indicated.
• A single, asymptomatic birth partner should be permitted to stay with the woman, at a minimum, through pregnancy and birth. Visitors should be instructed to wear appropriate PPE, including gown, gloves, face mask, and eye protection.
• Women should be met at the maternity unit entrance by staff wearing appropriate PPE and be provided with a surgical face mask. The face mask should not be removed until the woman is isolated in a suitable room
• Staff providing care should take Personal Protective Equipment (PPE) precautions as per national guidance.

Breastfeeding

• During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply.
• If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene.After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected as per the manufacturer’s instructions.
• This expressed breast milk should be fed to the new-born by a healthy caregiver.
• If a mother and new-born do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.

To access the complete guidelines, click here.