COVID-19 in pregnancy

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See COVID-19 for main article. For transmission precautions see: Prevention of COVID-19 transmission in the healthcare setting.

Background

  • Reported data and outcomes for pregnant patients similar to non-pregnant patients
    • Physiologic and immunologic changes in pregnancy may make them more susceptible to contracting viral respiratory illness but symptoms and outcomes demonstrate no significant differences from non-pregnant COVID19

Epidemiology

  • 34 pregnant women reported with COVID; 0 deaths reported.
  • Median age: 30 years (mostly 2nd and 3rd trimester -- median gestation 36 weeks)
  • Symptom onset within 13 days prior to, and 3 days after, delivery
  • Infants of affected mothers all tested negative
  • No maternal/pregnant deaths reported from COVID

Clinical Features

Differential Diagnosis

Evaluation

Management

Infection Prevention

  • Applies to broader infection prevention
  • Isolation of pregnant patients with COVID19 and PUIs
  • Pre-hospital (for confirmed COVID19 or PUI):
    • Notify OB unit prior to arrival
    • EMS: driver should contact receiving unit to follow local protocols
    • Hospitalization: usual hospital protocols for isolation
  • Infants born to mothers with COVID should be considered PUI
    • Prevention of mother-to-child transmission (PMTCT): may temporarily separate mother from baby until mother’s transmission based isolation precautions are discontinued (due to respiratory secretions)
      • No data on vertical transmission
        • Thought to spread mostly by close contact with respiratory droplet
      • Very limited data on routes of transmission other than contact with respiratory droplet - however small cohorts tested didn’t demonstrate transmission via these others routes (note amniotic fluid and other sources were not tested)
      • Discontinuation of isolation made on local ID guidance and case-by-case
      • Discontinuation criteria same as for other COVID19
        • Resolution of fever without anti-pyretic, resolution of symptoms, and negative COVID19 testing
      • Face mask, hand hygiene before each feeding
        • Dedicated breast pump if nursing
        • Entire pump should be entirely disinfected per manufacturer recommendations between each feed

Q&A Scenarios

  • Are pregnant women at increased risk of adverse pregnancy outcomes?
    • No data exists on this (regarding pregnancy loss, misscarriage, etc)
    • High fevers in early pregnancy previously demonstrated (in SARS and MERS) to increase risk of birth defects. May be possible here. But no data.
  • Lactation
    • No evidence of virus found in breastmilk. (but no good data on this). Most transmission noted to be due to close respiratory droplet contact during feeding
  • Should pregnant patients not be out and about in the community?
    • Prenatal care still encouraged
    • Usual precautions encouraged (as with general population)

Disposition

See Also

External Links

References