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March 13 Practice Advisory on Novel Corona Virus

From the latest CDC Practice Advisory:

Pregnant Women

The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. View the algorithm.

At this time, very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19.

Currently available data on COVID-19 does not indicate that pregnant women are at increased risk. However, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections such as influenza and SARS-CoV. As such, pregnant women should be considered an at-risk population for COVID-19. Adverse infant outcomes (eg, preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus. In limited recent case series of infants born to mothers infected with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for COVID-19 (1).

While travel history is always an essential component of medical history intake, obstetrician–gynecologists and other health care practitioners should be vigilant in obtaining a detailed travel history as well as a history of exposure to people with symptoms of COVID-19 for all patients, including pregnant women presenting with fever or acute respiratory illness and should follow the CDC’s Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) Infection and guidance for Evaluating and Reporting Persons Under Investigation (PUI). Of note, health care practitioners should immediately notify infection control personnel at their health care facility and their local or state health department in the event of a PUI for COVID-19.

Check with your hospital or the hospitals that your student will birth at and pass on the changes in protocol for them.

  1. How many "guests" will be allowed in their room?
  2. Will their doula be a "guest" or not counted as one? (per AWHONN, ACOG, CDC who all see the doula as a member of the team and important for emotional support)  DONA International has a good post HERE
  3. If they are diagnosed or are a Person Under Investigation (PUI), how will this change things? 
    1. Will they be separated from their baby?  
    2. Can they ask to room-in anyway? What restrictions
  4. How long with healthy moms and babies stay in the hospital?  (Most will be discharged sooner than later)
  5. If they are scheduled for induction or a cesarean, will that plan change?
  6. What PPE will they, their guests and the healthcare team use?
    1. All staff at my hospital are wearing masks during their whole shift
  7. Are there any other changes that your students need to know about?