Clinical Information for COVID-19 in Pregnancy

Last modified: March 31, 2020
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**Our knowledge of COVID-19 is changing daily. Due to this, these guidelines will likely be subject to frequent modification.**

What is COVID-19

  • Large, single-stranded RNA virus
  • Appearance of a crown (“corona” in Latin) on electron microscopy
  • First reported in December 2019 in Wuhan, China
  • Likely zoonotic in origin as it closely resembles bat coronavirus

How is COVID-19 Spread?

It is spread person to person via 

  • Airborne droplets
  • Direct contact with bodily fluids
  • Feces?

Symptoms (including but not limited to)

  • Fever
  • Cough
  • Shortness of breath
  • Fatigue
  • Sputum production
  • Headache
  • Sore Throat

Emergency Warning Signs

  • Difficulty breathing
  • Persistent chest pain
  • Confusion/lethargy
  • Cyanosis

Treatment

  • Supportive care
  • Fluid resuscitation
  • Electrolyte optimization
  • Respiratory support as indicated
    o Early intubation
    o NIPPV not recommended due to aeroslization
  • Drugs reserved for severe cases
    o Remdesivir
    – Potent antiviral
    – Compassionate use
    o Chloroquine
    – Broad spectrum antiviral
    – Apparent efficacy in treating COVID-19 associated pneumonia

Management Specific to Pregnancy

  • In two case series (total of 18 pregnant patients) only 1 pregnant patient required mechanical ventilation
  • It does not appear that women are at increased risk in pregnancy
  • It does not appear that women are at increased risk of spontaneous abortion or IUFD
  • Pregnant women can continue working in healthcare setting with proper precautions
    o Hand washing, limit exposure, PPE when indicated
  • COVID-19 is not an indication for delivery or for primary cesarean section.
  • Continuous fetal monitoring in the setting of severe illness should only occur when delivery would NOT compromise maternal health. In a critically ill patient, the health of the mother should always be the priority.
  • Anecdotal reports and expert opinion suggest improved outcomes with prone positioning in severe cases.
    o Gravid abdomen can be cushioned to allow for this
  • Steroid administration
    o Indicated delivery should not be delayed for steroid effect
    o Each patient should be evaluated on a case by case basis. Care should be taken in giving steroids to critically ill patients. Risks vs benefits must be weighed.
  • We are unsure if vertical transmission occurs

Breastfeeding

  • Women who deliver who are confirmed or suspected to have COVID-19 CAN breastfeed.
  • However, physical separation of mother/baby unit if feasible. Breastmilk should be expressed and then bottle fed to infant by an unaffected family or staff member.
  • If unable to separate mother and baby, mother should practice stringent hand hygiene and wear a mask while breastfeeding.

Use of Nitrous Oxide on L&D

  • Currently discouraged due to risk of aerosolization
  • Not currently being offered at UAMS

Medical Comorbidities That Could Impact COVID-19 in Pregnancy

  • Immuno-compromised/suppressed 
    o Transplant
    o Inflammatory Bowel Disease or Rheumatologic Disease 
    o Active treatment with biologics
    o Prednisone >20mg/d
  • Class III Obesity
  • Insulin Dependent or Poorly Controlled Diabetes
  • Maternal Cardiac Disease
  • Hypertension disease in pregnancy requiring medical therapy
  • Renal insufficiency
  • Moderate/Severe Respiratory Disease:
    o i.e. Asthma requiring treatment, CF
  • Neurologic Disease
    o Parkinson’s, ALS, spinal cord injury, seizure, CVA
  • Active cancer

Access the PDF for complete information related to COVID-19 and pregnancy.

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Some of these documents have been developed based on current needs and experiences. UAMS is an entity of the state which may have different requirements under federal and state law than your hospital, doctors, and other providers. This information is provided as a public service in response to continuing questions from various community providers. All information is subject to change as our response to this pandemic challenge continues. Consult your practice or facility leadership before adopting any practices or protocols provided here.