COVID-19 in pregnancy: Difference between revisions
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==Special Population: Pregnant Women== | |||
===Background Epidemiology=== | |||
* 34 pregnant women reported with COVID | |||
* 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 | |||
===Bottom Line for Pregnant Patients=== | |||
* 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 | |||
===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) | |||
===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 |
Revision as of 20:05, 19 March 2020
See COVID-19 for main article
Background
Clinical Features
Differential Diagnosis
Evaluation
Management
Disposition
See Also
External Links
References
Special Population: Pregnant Women
Background Epidemiology
- 34 pregnant women reported with COVID
- 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
Bottom Line for Pregnant Patients
- 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
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)
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
- No data on vertical transmission
- 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)