CMAAO
CORONA FACTS and MYTH BUSTER 99 Pregnancy
Dr K K Aggarwal
President Confederation of Medical Associations of
Asia and Oceania, HCFI, Past National President IMA, Chief Editor Medtalks
888: Pregnancy and COVIUD
19Source UPTODATE
1. Pregnant women should
follow the same recommendations as nonpregnant persons for avoiding exposure to
the VOVID virus.
2. Pregnant health workers in
the third trimester, particularly those ≥36 weeks, stop face-to-face contact
with patients.
3. Clinical manifestations of
COVID-19 in pregnant women are similar to those in nonpregnant individuals.
4. A positive test for
SARS-CoV-2 generally confirms the diagnosis of COVID-19, although
false-positive and false-negative tests are possible.
5. Pregnancy does not appear
to increase susceptibility to infection or worsen the clinical course, and most
infected mothers recover. However,
severe disease necessitating maternal intensive care unit admission and need
for extracorporeal membrane oxygenation can occur.
6. Infected women, especially
those who develop pneumonia, appear to have an increased frequency of preterm
birth and cesarean delivery. These complications are likely related to severe
maternal illness as intrauterine infection does not appear to occur, but this
is still under investigation. A few possible early newborn infections and one
possible placental infection have been reported.
7. The American College of
Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal
Medicine (SMFM) have issued guidance regarding prenatal care during the
COVID-19 pandemic
8. For the general
population, the Centers for Disease Control and Prevention recommend avoiding
glucocorticoids in COVID-19-positive persons because of the potential for adverse
effects on the course of the disease. Because of the clear benefits of
antenatal betamethasone administration
between 24+0 and 33+6 weeks of gestation in patients at risk of preterm birth
within seven days, ACOG continues to recommend its use for standard indications
to pregnant patients with suspected or confirmed COVID-19.
9. For most women with
preterm COVID-19 and nonsevere illness who have no medical/obstetric
indications for prompt delivery, delivery is not indicated and ideally will
occur sometime after a negative testing result is obtained or isolation status
is lifted, thereby minimizing the risk of postnatal transmission to the neonate.
Severely ill patients at least 32 to 34 weeks of gestation with COVID-19
pneumonia may benefit from early delivery.
10. In areas where the
infection is active, we believe testing all patients upon presentation to labor
and delivery (or the day before if a scheduled admission) is reasonable, if testing
is available. In a city with a high infection prevalence, a high proportion of
asymptomatic patients (13.5 percent in one study) admitted for delivery tested
positive, which has clinical implications for triage, staff, and newborn care.
11. Generally, management of
labor is not altered in women giving birth during the COVID-19 pandemic or in
women with confirmed or suspected COVID-19. SARS-CoV-2 has not been detected in
vaginal secretions or amniotic fluid, so rupture of fetal membranes and internal
fetal heart rate monitoring may be performed for usual indications, but data
are limited. COVID-19 is not an indication to alter the route of delivery. The
partner/support person should be screened in accordance with hospital policies
and those with any symptoms consistent with COVID-19, exposure to a confirmed
case within 14 days, or a positive test for COVID-19 within 14 days should not
be allowed to attend the labor and birth.
12. In patients with known or
suspected COVID-19, neuraxial anesthetic is not contraindicated and has several
advantages in laboring patients. The Society of Obstetric Anesthesia and
Perinatology suggests suspending use of nitrous oxide for labor analgesia in
these patients because of insufficient data about potential aerosolization of
nitrous oxide systems.
13. At delivery of patients
with known or suspected COVID-19, some institutions have chosen to prohibit
delayed cord clamping in term infants, in whom the benefits are modest, to
minimize newborn exposure to any virus in the immediate environment and reduce
the chances that the newborn will require phototherapy for jaundice.
14. NSAIDs are commonly used
for treatment of postpartum pain; however, there are anecdotal reports of
possible negative effects of NSAIDs in patients with COVID-19. Given the
uncertainty, use paracetamol (acetoaminophen). If NSAIDs are needed, the lowest
effective dose should be used.
15. Infants born to mothers
with known COVID-19 are COVID-19 suspects and should be tested, isolated from
other healthy infants, and cared for according to infection control precautions
for patients with confirmed or suspected COVID-19.
16. Whether to separate a
mother with known or suspected COVID-19 and her infant is determined on a
case-by-case basis. If the infant tests positive, separation is unnecessary. If
separation is indicated (mother is on transmission-based precautions) but not
implemented, other measures may be utilized to reduce potential
mother-to-infant transmission, including physical barriers and ≥6 feet
separation, personal protective equipment and hand hygiene, and utilization of
other healthy adults for infant care (feeding, diapering, bathing).
17. The virus has only been
found in one sample of breast milk, but data are limited.
18. Droplet transmission to
the new-born could occur through close contact during feeding.
19. In mothers with confirmed
COVID-19 or symptomatic mothers with suspected COVID-19, to minimize direct
contact, ideally, the infant is fed expressed breast milk by another caregiver
until the mother has recovered or been proven uninfected, provided that the
other caregiver is healthy and follows hygiene precautions. In such cases, the
mother should wear a mask and thoroughly clean her hands and breasts before
pumping; the pump parts, bottles, and artificial nipples should be cleaned as
well. If she breastfeeds the infant directly, similar personal hygienic
precautions should be taken.
20. Remdesivir is the most promising and has
been used without reported fetal toxicity in some severely ill pregnant women.
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