Given the rise in positive cases of coronavirus in the state of Michigan, all Obstetrical care providers should be aware of the new COVID-19 Algorithm that was recently published jointly by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine. This algorithm is designed to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. The Novel Coronavirus 2019 ACOG Practice Advisory has additionally been updated to suggest providers should contact their local and/or state health department for guidance on testing persons under investigation (PUI).
Steps Included in the Algorithm:
Assess Patients Symptoms: Typically include fever ≥ 38°C (100.4°F) or one or more of the following:
- Cough
- Difficulty breathing or shortness of breath
- Gastrointestinal symptoms
Conduct Illness Severity Assessment-Ask Key Questions:
- Does she have difficulty breathing or shortness of breath?
- Does she have difficulty completing a sentence without gasping for air or a need to stop to catch breath frequently when walking across the room?
- Does the patient cough more than 1 teaspoon of blood?
- Does she have new pain or pressure in the chest other than pain when coughing?
- Is she unable to keep liquids down?
- Does she show signs of dehydration such as dizziness when standing?
- Is she less responsive than normal or does she become confused when talking to her?
Assess Clinical and Social Risks
- Comorbidities (hypertension, diabetes, asthma, HIV, chronic heart disease, chronic liver disease, chronic lung disease, chronic kidney disease, blood dyscrasia, and people on immunosuppressive medications)
- Obstetric issues (e.g. Preterm labor)
- Inability to care for self or arrange follow up if necessary
Determine Overall Risk-Elevated, Moderate or Low
Low Risk
- Refer patient for symptomatic care at home including hydration and rest
- Monitor for development of any symptoms above and re-start algorithm if new symptoms present
- Routine obstetric precautions
Moderate Risk
- See the patient as soon as possible in an ambulatory setting with resources to determine severity of illness.
- When possible, send patient to a setting where she can be isolated. Clinical assessment for respiratory compromise includes physical examination and tests such as pulse oximetry, chest x-ray, or ABG as clinically indicated. Pregnant women (with abdominal shielding) should not be excluded from chest CT if clinically indicated.
Elevated Risk
- Recommend she immediately seek care in an emergency department or equivalent unit that treats pregnant women. When possible, sent patient to a setting where she can be isolated.
- Notifying the facility that you are referring a PUI is recommended to minimize the chance of spreading infection to other patients and/or healthcare workers at the facility.
- Adhere to local infection control practices including personal protective equipment.
Due to the rapidly evolving nature of this situation, please use the resources listed below for the most up to date information.
ACOG Practice Advisory: Novel Coronavirus 2019 (COVID-19): https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019
Michigan Department of Health and Human Services (MDHHS): www.michigan.gov/coronavirus
World Health Organization (WHO): www.who.int/emergencies/diseases/novelcoronavirus-2019
Centers for Disease Control and Prevention (CDC):
- https://www.cdc.gov/coronavirus/2019-ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html
- https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html?deliveryName=USCDC_946-DM20867
- https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
- https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
- https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html