During these Covid times, there are certain frequently asked questions by pregnant ladies and their relatives. Following are some relevant FAQs answered by American College of Obstetricians and Gynecologists(ACOG). These FAQs are developed by several Task Forces who are on the frontline caring for patients during this pandemic.
Health care professionals have been encouraged to share ACOG’s patient resources as appropriate. Hence, I circulating these details for awareness of all concerned.
Available data suggest that symptomatic pregnant women with COVID-19 are at increased risk of more severe illness compared with non-pregnant peers. Although the absolute risk for severe COVID-19 is low, these data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support, and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women.
Importantly, analyses so far are limited by a large amount of missing data. Yet, there are insufficient data that stratifies this risk by gestational age, wearing a facemask, capacity to screen for SARS CoV-2 infection, or the effect of the level of community prevalence of SARS-CoV-2 infection.
Importantly, pregnant individuals may continue to work until they give birth. For many women, not working is not feasible. ACOG recommends that:
Pregnant individuals who continue to work should be provided with the ability to occupy roles in which there is reduced risk of exposure to COVID-19 if they so choose.
Employers follow current CDC guidance and direction from local and state health departments (CDC).
Employers assess the hazards to which their workers may be exposed; evaluate the risk of exposure; and select, implement, and ensure workers use controls to prevent exposure.
Prevention practices, including physical distancing, hand hygiene, surface decontamination, and wearing a cloth face covering or facemask (for source control), should be applied to all individuals given the potential for asymptomatic SARS-CoV-2 transmission.
Accommodations related to the work environment specific to non-pregnant employees with comorbidities should be applied to pregnant employees with similar comorbidities. This is because pregnant individuals with comorbidities continue to be at increased risk of severe illness consistent with the general population with similar comorbidities.
If a pregnant individual requests a letter to support a COVID-19-specific work accommodation, maternal health care professionals can respond to the request in the context of the risk to the pregnant individual considering the particular patient’s circumstances. Further, maternal health care professionals should advocate for every possible protection from exposure to COVID-19 (e.g., masks, gloves, remote working, proper ventilation, etc) for pregnant women in the workplace.
Antenatal fetal surveillance and ultrasonography should continue as medically indicated when possible. Elective ultrasound examinations should not be performed, and ultrasonography should be used prudently and only when its use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. Prior to any in-person visit, clinicians should inform patients of any guidance in place regarding visitors. Visitors must be screened prior to entering the clinic space. ACOG recommends all individuals older than two years of age wear a mask or cloth face-covering in public and when around people outside of the household, especially in settings where other social distancing measures are not feasible. In particular, all persons entering a health care facility should wear a cloth face covering or facemask for the duration of their visit.
It may be appropriate to postpone or cancel some testing or examinations if the risk of exposure and infection within the community outweighs the benefit of testing. However, this should be a decision made at the local practice or facility level, balancing the risks and benefits of decreased exposure, completing the test, and site capacity. As with other components of prenatal care, reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal antenatal testing or ultrasonography scheduling should resume when this risk subsides. Any modifications made to care should be relayed to patients with a discussion of the altered balance of risks and -benefits of coming to the office for testing or ultrasonography in the setting of a global pandemic and should be documented in the medical record.
Although recognizing that many patients are experiencing new concerns because of the COVID-19 pandemic, hospitals and accredited birth centers remain the safest settings for birth even during COVID-19. Although the absolute risk for severe COVID-19 is low, available data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support, and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women highlight the importance of delivering at a hospital or accredited birth center. Patients concerned that delivering in a hospital or accredited birth center setting will increase their risk of exposure to COVID-19 should be assured that hospitals and accredited birth centers continue to be safe with strict infection control procedures.
Yes. Maternal immunizations continue to be an essential component of prenatal care during the COVID-19 pandemic. Adhering to the recommended timing of maternal immunization as much as possible is encouraged to maximize maternal and fetal benefits. If a practice decides to modify or reduce the number of prenatal care visits, clinicians are encouraged to include recommended maternal immunizations during remaining in-person appointments, even if that means immunizations will be administered outside of the typically recommended weeks of gestation. Modified prenatal care schedules during COVID-19 may make it disproportionately more difficult for some to receive preventive care such as maternal immunizations. This reality underscores the importance of clinicians integrating social determinants of health screening into practice, and maximizing and facilitating referrals to social services. Importantly, there is no evidence that vaccination with either the influenza vaccine or Tdap vaccine increases a pregnant woman’s or fetus’ risk of infection with or complications from the virus that causes COVID-19. Similar to other infectious diseases, if a postpartum individual has suspected or confirmed COVID-19 and did not receive indicated immunizations prior to or during pregnancy, those immunizations should be delayed until the patient has fully recovered from illness.
No. While there are cases of reported vertical transmission of SARS-CoV-2, currently available data indicate that vertical transmission appears to be uncommon. There is growing evidence suggesting an increased risk of ICU admission, mechanical ventilation, and death for symptomatic pregnant patients with COVID-19, but these findings are not an indication for cesarean delivery. Cesarean delivery should therefore be based on obstetric (fetal or maternal) indications and not COVID-19 status alone. In the event that an individual should request a cesarean delivery because of COVID-19 concerns, obstetrician-gynaecologists and other obstetric care clinicians will follow ACOG’s guidance for Cesarean Delivery on Maternal Request.
Respiratory diseases are typically not transmitted by the transfer of human cells. Currently, there are no reported cases of transmission of COVID-19 by blood products (FDA); therefore, umbilical cord blood banking can continue to be managed according to clinical guidance, in the setting of appropriate clinician personal protective equipment. A variety of circumstances may arise during the process of labour and delivery that may preclude adequate cord blood collection. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter the routine practise of delayed umbilical cord clamping with the rare exception of medical indications for directed donation.
Yes. To limit the risk of inadvertent exposure and infection, it may be appropriate to expedite discharge when both the mother and the infant are healthy. For example, discharge may be considered after 1 day for women with uncomplicated vaginal births and after 2 days for women with cesarean births depending on their status. An early discharge will require discussion with the facility’s pediatric care team and should be linked to home telehealth visits for mother and infant.