On March 10, 2020 the state of Michigan announced that two Michigan residents tested presumptive positive for coronavirus disease 2019. These are the first confirmed cases in the state. As result, the Governor has declared a state of emergency to maximize efforts and assist local governments to slow the spread of the virus.
Health care facilities and providers should be on heightened alert for continued spread of the disease. Front-line healthcare personnel in the United States should be prepared to evaluate patients for coronavirus disease 2019 (COVID-19).
ACOG recently posted a Practice Advisory regarding Novel Coronavirus 2019 (COVID-19). In it they noted that the immediate health risk from COVID-19 is considered low for the general population. “it is believed that pregnant women may be at higher risk of severe illness, morbidity, or mortality compared with the general population (1-3). Adverse infant outcomes (eg, preterm birth) also have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus. There have been a few unsubstantiated reports of infants testing positive for the virus shortly after birth, but validated data is required to understand how these infants were infected and whether-or-not the virus can be transmitted during pregnancy. In limited recent case series of infants born to mothers infected with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for COVID-19 (1).”
Recommendations Include:
- Avoid all non-essential travel to the People’s Republic of China.
- Obstetrician–gynecologists and other health care practitioners should obtain a detailed travel history for pregnant patients presenting with fever and acute respiratory illness and should follow the CDC’s Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection and guidance for Evaluating and Reporting Persons Under Investigation (PUI). Of note, health care practitioners should immediately notify infection control personnel at their health care facility and their local or state health department in the event of a PUI for COVID-19.”
Infection Prevention and Control in Inpatient Obstetric Care Setting:
CDC has published Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. These considerations apply to health care facilities providing obstetric care for pregnant patients with confirmed COVID-19 or pregnant persons under investigation (PUI) in inpatient obstetric health care settings including obstetrical triage, labor and delivery, recovery and inpatient postpartum settings
The American College of Obstetricians and Gynecologists encourages physicians and other obstetric care practitioners to read and familiarize themselves with the complete list of recommendations.
Key highlights from the recommendations include:
- 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 PUI.
- Place a patient with known or suspected COVID-19 (ie, PUI) in an Airborne Infection Isolation Room (AIIR) that has been constructed and maintained in accordance with current guidelines. If an AIIR is not available, patients who require hospitalization should be transferred as soon as feasible to a facility where an AIIR is available.
- Infants born to mothers with confirmed COVID-19 should be considered PUIs. As such, these infants should be isolated according to the Infection Prevention and Control Guidance for PUIs.
- To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (eg, separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued.
- Discharge for postpartum women should follow recommendations described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19.
Due to the limited data on COVID-19, these recommendations are largely based on infection prevention and control considerations for other respiratory viruses such as influenza, SARS-CoV and MERS-CoV and are intentionally cautious as experts learn more about this new virus.
Breastfeeding:
Follow CDC Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19, key points include:
- Determine whether to start or continue breastfeeding by the mother in coordination with her family and health care practitioners.
- Unclear if the virus can be transmitted through breastmilk but concerns it can be transmitted through respiratory droplets during breastfeeding.
- A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spread of the virus to her infant including: hand washing, wearing a face mask, washing all breast pump and bottle parts thoroughly after each use.
- If possible, have someone who is well feed the expressed breast milk to the infant.
Precautions for Health Care Personnel:
The CDC recommends that all health care personnel who enter the room of a patient with known or suspected COVID-19 (persons under investigation) should adhere to Standard, Contact, and Airborne Precautions. See the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings for detailed recommendations.
Due to the rapidly evolving nature of this situation, please use the resources listed below for the most up to date information.
OB Specific Resources:
- ACOG Practice Advisory: Novel Coronavirus 2019 (COVID-19): https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019
- https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html?deliveryName=USCDC_946-DM20867
- https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
- Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19
General Resources:
Michigan Health & Hospital Association: Resources for Hospitals and Healthcare Providers and Healthcare Personnel Safety: https://mha.org/Issues-Advocacy/Coronavirus
Michigan Department of Health and Human Services (MDHHS): www.michigan.gov/coronavirus
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/infection-control/control-recommendations.html
- https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
World Health Organization (WHO): https://www.who.int/health-topics/coronavirus#tab=tab_1