Am J Perinatol 2020; 37(08): 773-779
DOI: 10.1055/s-0040-1710051
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Considerations for Obstetric Care during the COVID-19 Pandemic

Sarah K. Dotters-Katz
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
,
Brenna L. Hughes
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
› Institutsangaben
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Publikationsverlauf

06. April 2020

06. April 2020

Publikationsdatum:
17. April 2020 (online)

Abstract

The novel coronavirus disease 2019 (COVID-19) is a growing pandemic that is impacting daily life across the globe. Though disease is often mild, in high-risk populations, severe disease often leads to intubation, intensive care admission (ICU) admission, and in many cases death. The implications for pregnancy remain largely unknown. Early data suggest that COVID-19 may not pose increased risk in the pregnant population. Vertical transmission has not been confirmed. Because no treatment, no vaccine and no herd immunity exist, social distancing is the best mechanism available to protect patients and health care workers from infection. This review will discuss what is known about the virus as it relates to pregnancy and then consider management considerations based on these data.

Key Points

  • COVID-19 severity in pregnancy is unclear.

  • Social distancing is the best protective mechanism.

  • No clear evidence of vertical transmission exists.

  • Mother/baby separation avoids transmission.

 
  • References

  • 1 Linton NM, Kobayashi T, Yang Y. , et al. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: a statistical analysis of publicly available case data. J Clin Med 2020; 9 (02) E538
  • 2 Kucharski AJ, Russell TW, Diamond C. , et al; Centre for Mathematical Modelling of Infectious Diseases COVID-19 working group. Early dynamics of transmission and control of COVID-19: a mathematical modelling study. Lancet Infect Dis 2020; S1473-3099(20)30144-4
  • 3 Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, evaluation and treatment coronavirus (COVID-19). In: Abai B, Abu-Ghosh A, Acharya AB. , et al, eds. StatPearls. Treasure Island, FL: 2020
  • 4 CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (12) 343-346
  • 5 Control ECfDPa. Daily risk assessment on COVID-19, 13 March 2020. In: Control ECfDPa ed; 2020. . Available at: https://www.ecdc.europa.eu/en/current-risk-assessment-novel-coronavirus-situation . Accessed April 13, 2020
  • 6 Lei Pan MM, Hong GR, Yang P. , et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020 . Available at: https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf . Accessed April 13, 2020
  • 7 Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E. , et al; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623
  • 8 Bhatraju PK, Ghassemieh BJ, Nichols M. , et al. Covid-19 in critically ill patients in the Seattle region - case series. N Engl J Med 2020; 382: 2012-2022
  • 9 Shi H, Han X, Jiang N. , et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20 (04) 425-434
  • 10 Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol 2020 . Doi: 10.1001/jamacardio.2020.1286
  • 11 Wang D, Hu B, Hu C. , et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323 (11) 1061-1069
  • 12 Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis 2020; S1473-3099(20)30195-X
  • 13 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46 (05) 846-848
  • 14 Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China] (in Chinese). Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41 (02) 145-151
  • 15 Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 2020; 395 (10223): 473-475
  • 16 Gautret P, Lagier JC, Parola P. , et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020; 105949
  • 17 Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care 2020; S0883-9441(20)30390-7
  • 18 Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle east respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: report of two cases & review of the literature. J Microbiol Immunol Infect 2019; 52 (03) 501-503
  • 19 Wong SF, Chow KM, Leung TN. , et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191 (01) 292-297
  • 20 Rasmussen IS, Mortensen LH, Krause TG, Nybo Andersen AM. The association between seasonal influenza-like illness cases and foetal death: a time series analysis. Epidemiol Infect 2018; 147: 1-7 . Doi: 10.1017/S0950268818003254. (Epub ahead of print)
  • 21 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
  • 22 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; ciaa200
  • 23 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
  • 24 Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020 . Doi: 10.1016/j.jinf.2020.02.028. (e-pub ahead of print)
  • 25 Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available at: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf . Accessed April 8, 2020
  • 26 Yu N, Li W, Kang Q. , et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; S1473-3099(20)30176-6
  • 27 Chen S, Liao E, Shao Y. Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia. J Med Virol 2020
  • 28 Breslin NB, Baptiste C, Miller R. , et al. COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol MFM 2020 (e-pub ahead of print) Doi: 10.1016/j.ajogmf.2020.100111
  • 29 Fell DB, Savitz DA, Kramer MS. , et al. Maternal influenza and birth outcomes: systematic review of comparative studies. BJOG 2017; 124 (01) 48-59
  • 30 Alserehi H, Wali G, Alshukairi A, Alraddadi B. Impact of Middle East Respiratory Syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis 2016; 16: 105
  • 31 Moore SA, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg 2016; 151 (04) 1154-1160
  • 32 Centers for Disease Control and Prevention (CDC). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)–United States, April 2009-August 2010. Morb Mortal Wkly Rep 2011; 60 (35) 1193-1196
  • 33 Chen S, Huang B, Luo DJ. , et al. [Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49 (00) E005
  • 34 Zeng L, Xia S, Yuan W. , et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020 (e-pub ahead of print) Doi: 10.1001/jamapediatrics.2020.0878
  • 35 Dong L, Tian J, He S. , et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA 2020
  • 36 ACOG. Outpatient Assessment and Management for Pregnant Women With Suspected or Confirmed Novel Coronavirus (COVID-19). Available at: http://www.vdh.virginia.gov/content/uploads/sites/13/2020/03/COVID-19_Algorithm5.pdf . Accessed April 8, 2020
  • 37 American College of Obstetricians and Gynecologists; Public Health Preparedness Expert Work Group. COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics. Available at: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics . Accessed April 8, 2020
  • 38 The Society for Maternal-Fetal Medicine (SMFM). Sarah Dotters-Katz M, MMHPE; and Brenna L. Hughes, MD, MSc. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2262/COVID19_PDF.pdf . Accessed April 8, 2020
  • 39 CDC. What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients-H.pdf . Accessed April 8, 2020
  • 40 ACOG Practice Bulletin No. ACOG practice bulletin no. 211: critical care in pregnancy. Obstet Gynecol 2019; 133 (05) e303-e319
  • 41 Mhyre JM, D'Oria R, Hameed AB. , et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol 2014; 124 (04) 782-786
  • 42 Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med 2011; 32 (01) 1-13
  • 43 CDC. Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19. Available at: http://www.e-lactancia.org/media/papers/Interim_Guidance_on_Breastfeeding_for_a_Mother_COVID-19-CDC-2020.pdf . Accessed April 8, 2020