Clinical Information for COVID-19 in Pregnancy

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
  • Early intubation
  • NIPPV not recommended due to aeroslization
• Drugs reserved for severe cases
  • Remdesivir
    • Potent antiviral
    • Compassionate use
  • 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
  • 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.
  • Gravid abdomen can be cushioned to allow for this
• Steroid administration
  • Indicated delivery should not be delayed for steroid effect
  • 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 
  • Transplant
  • Inflammatory Bowel Disease or Rheumatologic Disease 
  • Active treatment with biologics
  • 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:
  • i.e. Asthma requiring treatment, CF
• Neurologic Disease
  • Parkinson’s, ALS, spinal cord injury, seizure, CVA
• Active cancer

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