**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
Symptoms (including but not limited to)
- Shortness of breath
- Sputum production
- Sore Throat
Emergency Warning Signs
- Difficulty breathing
- Persistent chest pain
- 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
– Potent antiviral
– Compassionate use
– 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
- 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
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.