The American College of Obstetricians and Gynecologists (ACOG) has recently updated the Practice Advisory regarding the Novel Coronavirus and they continue to monitor the COVID-19 pandemic closely. The Practice Advisory was created to aid clinicians in providing front line care during the pandemic.
Key Updates to the Practice Advisory:
- The recommendation regarding testing on labor and delivery units has been strengthened.
- Clarification of recommendations regarding COVID-19 and risk to pregnant women.
- Addition of a section addressing health care inequities.
- Revision of section on personal protective equipment, to include all medical staff caring for potential or confirmed CIVID-19 patients should use personal protective equipment (PPE), including respirators (e.g. N95 respirators), eye protection, gloves and gowns.
The National Institute of Health has compiled data from the Centers for Disease Control and Prevention (CDC), ACOG, and the Society for Maternal and Fetal Medicine on the management of pregnant patients with COVID-19. They note that there is limited information available regarding the effect of COVID-19 on obstetric or neonatal outcomes, and there are limited case reports and series for review. Also noted is that if hospitalization is indicated for pregnant patients with COVID-19, care should be provided in a facility that has the capability to monitor the maternal and fetal status closely.
The principles of management of COVID-19 in the pregnant patient may include:
- Fetal and uterine contraction monitoring.
- Individualized delivery planning.
- A team-based approach with multispecialty consultation.
- Timing of delivery dictated by obstetric indications rather than a maternal diagnosis of COVID-19.
- Postponement of delivery for women with suspected or confirmed COVID-19 in the third trimester until a negative test result is obtained or quarantine restrictions lifted to avoid transmission of the virus to the neonate.
- A diagnosis of COVID-19 in pregnancy is not an indication for early delivery.
- No risk of vertical transmission via transplacental route based on limited data.
- No FDA approved medications for the treatment of COVID-19 in pregnancy.
- Most clinical trials have excluded pregnant and lactating women; enrollment is encouraged if eligible.
Recommendations post-delivery include:
- A temporary separation of newborn infants from mothers who are persons under investigation (PUI) or who have COVID-19 due to concern for transmission to the infant via respiratory droplets. If separation occurs, expression of breastmilk for feeding, from a dedicated pump, and consideration for a healthy person to feed the infant.
- Breastfeeding recommendations include decisions on how and when to start or continue breastfeeding with the mother/family and health care practitioners. CDC and ACOG have put out guidance on breastfeeding and the need for proper hand hygiene and facemask for COVID-19 positive mothers. Of note, COVID-19 has not been isolated in breastmilk.
Consideration should be given by obstetrical provider for referral to either the PRIORITY Study or SONPM National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection (NPC-19) for any pregnant or recently pregnant patients with known or suspected Coronavirus (COVID-19) to obtain further understanding of how COVID-19 impacts pregnancy and newborns.
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
- ACOG and Society for Maternal Fetal Medicine Algorithm English
- ACOG and Society for Maternal Fetal Medicine Algorithm Spanish
- NIH COVID-19 Treatment Guidelines
- Coronavirus Practice Management Society for Maternal-Fetal Medicine
- PRIORITY Study
- SONPM National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection (NPC-19)
Centers for Disease Control and Prevention (CDC):
- Considerations for Inpatient Obstetric Healthcare Settings
- Interim Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
- Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)
- Care for Breastfeeding Women
- CDC FAQs Pregnancy and Breastfeeding
- Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
- Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)