Original Article: Liona C. Poon, Huixia Yang, Jill C.S. Lee, Joshua A. Copel Tak Yeung Leung Yuanzhen Zhang Dunjin Chen Federico Prefumo, ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals, Ultrasound in Obstetrics and Gynaecology
Author of summary: Gianmarco Taraschi; Reviewer: Daria Di Filippo
Original Article Published on March 11th, 2020
Guidelines released by the International Society of Ultrasounds in Obstetrics and Gynaecology on the COVID-19 infection in pregnancy and puerperium.
• Maintain good personal and social hygiene: hand wash and use hand sanitizer (with 70% alcohol concentration) frequently.
• Wearing a three-ply surgical mask when visiting a hospital or other high-risk area has been recommended by some national health authorities and some hospital systems.
• Seek medical assistance promptly when experiencing fever and cough.
FOR HEALTH CARE PROFESSIONALS
•Set up triage plans for screening all pregnant patients who present to the hospital.
•Consider reducing the number of visitors to the department.
• All routine follow-up appointments should be postponed by 14 days or until test results: For routine group-B streptococcus (GBS) screening, Intrapartum prophylactic antibiotic cover for women with ante- or intrapartum risk factors for GBS is an alternative.
• Consider home confinement in a mild clinical presentation ensuring the monitoring of pregnancy.
•Chest X-ray examination and CT scan can be performed.
• in designated tertiary hospitals, suspected/probable cases should be treated in isolation, confirmed
cases should be managed in a negative-pressure isolation room and critically ill patients should be admitted to a in an ICU with negative-pressure isolation room.
•General treatment: maintain fluid and electrolyte balance and symptomatic treatment, such as antipyrexic, antidiarrheal medicines.
•Maternal surveillance: close and vigilant monitoring of vital signs and oxygen saturation level (to be kept > 94%); conduct arterial blood-gas analysis; regular evaluation of complete blood count, renal/liver function testing and coagulation testing.
•Pregnant women should be monitored with 2–4-weekly ultrasound assessment of fetal growth (Consider using protective covers for probes and cables especially of performing a Transvaginal US).
•Fetal monitoring: cardiotocography (CTG) for fetal heart rate (FHR) monitoring when pregnancy is >26–28 weeks of gestation, and ultrasound assessment of fetal growth and amniotic fluid volume with umbilical artery Doppler if necessary.
• If antiviral treatment is considered discuss with the patient the risk of IUGR. Add antibiotic treatment if suspected/confirmed secondary bacterial infection.
• For severe cases a left lateral position and an aggressive treatment is required, including supporting measures with hydration, oxygen therapy and chest physiotherapy. If septic shock: fluid resuscitation and inotropes to maintain an average arterial pressure ≥ 60 mmHg and a lactate level < 2 mmol/L.
•All medical staff involved in management of infected women should wear PPE as required.
•Medical staff who are caring for suspected, probable or confirmed cases of COVID-19 patients should be monitored closely .Medical staff who have been exposed unexpectedly, while without PPE, to a COVID-19-infected pregnant patient, should be quarantined or self-isolate for 14 days.
• Timing and mode of delivery should depend on the clinical status of the patient, gestational age and fetal condition:
shortening the second stage by operative vaginal delivery can be considered, as active pushing while wearing a surgical mask may be difficult
delivery should be conducted in a negative-pressure isolation room.
•For the protection of the medical team, water birth should be avoided.
•In preterm labour: the use of antenatal steroids should be considered in discussion with infectious-disease specialists, maternal–fetal-medicine subspecialists and neonatologists and tocolysis should be avoided if to offer steroids.
•Septic shock, acute organ failure or fetal distress should prompt emergency Cesarean delivery (or termination, if legal, before fetal viability)
•umbilical cord should be clamped promptly and the neonate should be transferred to the resuscitation area for assessment by the attending pediatric team.
•Miscarried embryos/fetuses and placentae of COVID-19-infected pregnant women should be treated as infectious tissues and tested by qRT-PCR.
• insufficient evidence regarding the safety of breastfeeding and the need for mother/baby separation:
If the mother is severely or critically ill, separation appears to be the best option, with attempts to express breastmilk in order to maintain milk production