Coronavirus in pregnancy: Dr Sarah Merritt 

The following information is based on the Royal College of Obstetricians and Gynaecologists Coronavirus (COVID-19) Infection in Pregnancy published on 9th March 2020.

Information regarding coronavirus is constantly being updated and therefore information may change.

Novel Coronavirus is a new strain of corona virus causing COVID-19.  The common cold and SARS (severe Acute Respiratory Syndrome (SARS-CoV) are also coronavirus infections.

It was first identified in Hubei Province in China, which remains the country with the highest number of cases; Italy is currently the most affected country in Europe.

 

Symptoms include

A cough

A high temperature

Shortness of breath

All of these symptoms are similar to other illnesses that are more common including the common cold and flu.

Pregnant women do not appear to be more susceptible to the consequences of infection with COVID-19 than the general population based on the current data.  Special consideration should be given to pregnant women who have a co-existing medical illness.

More severe symptoms of COVID-19 such as pneumonia and reduced oxygen intake are widely described in older people, people with reduced immunity and those with long term health problems such as diabetes, cancer and chronic lung disease.  If these symptoms occur in pregnancy, they need to be treated promptly.

 

Spread

Most cases of COVID-19 have been from human to human, there are some recent cases where there is no evidence of contact with an infected person.  The virus appears to spread via re cough droplets, faeces and objects or materials likely to carry infection such as utensils and clothing.  There is one reported case of transmission from mother to baby which probably occurred after delivery and not during the pregnancy. This is based on current expert opinion.

 

Advice

 

Travel

Pregnant women should follow the advice given by the Foreign and Commonwealth Office available on the UK Government website

Any one travelling must ensure that they have adequate travel insurance in place prior to travel.  If you are pregnant please check that you insurance will provide cover for birth and care of a newborn baby, if you give birth abroad

 

Possible exposure or symptoms of COVID-19

If you are concerned about exposure please call NHS 111 or use the NHS’s 111 tool.  Please DO NOT visit your GP or A&E in person.  If it is an emergency please call 999 and tell the operator about possible COVID-19 exposure.

If you are returning from areas of the world which indicate a possible increased risk of coronavirus transmission or who have been in contact with a known case of COVID-19 please phone NHS 111 or your GP.

At present the following countries are at increased risk of transmission

  • Cambodia
  • China
  • Hong Kong
  • Iran
  • Italy
  • Japan
  • Laos
  • Macau
  • Malaysia
  • Myanmar (Burma)
  • Singapore
  • South Korea
  • Taiwan
  • Tenerife – only the H10 Costa Adeje Palace Hotel
  • Thailand
  • Vietnam

If you’ve been to one of these places in the last 14 days:

  • stay at home and avoid close contact with other people
  • do not go to a GP surgery, pharmacy or hospital
  • use the NHS 111 online coronavirus service to find out what to do next

The 111 coronavirus service will tell you if you need to continue to stay at home (self-isolate) or if you need medical help.

Diagnostic swabs will be arranged if indicated.  If you have symptoms suggestive of COVID-19 please self isolate until advised otherwise.

 

Self-isolation for women with possible or confirmed COVID-19

If you have been advised to self-isolate, stay indoors and avoid contact with others for 14 days.  Public Health England provides guidance for

People who are advised to self-isolate and people who live in the same accommodation as someone who is self-isolating

For women who are advised to self-isolate, current guidance recommends to:

  • Not go to school, works, NHS settings or public areas
  • Not to use public transport
  • Stay at home and not allow visitors
  • Ventilate the rooms where they are by opening a window
  • Separate themselves from other members of their household as far as possible, using their own towels, crockery and utensils and eating at different times
  • Use family, friends or delivery services to run errands, but advise then to leave items outside

Women should be advised to contact their maternity care provider (e.g. midwife or antenatal clinic), to discuss attendance for routine antenatal appointments.

 

Pregnant women who are due to attend routine maternity appointments in the UK should contact their maternity care provider, to inform them that they are currently in self-isolation for possible/confirmed COVID-19, and request advice on attendance.

 

Pregnant women are advised not to attend maternity triage units or A&E unless in need of urgent

obstetric or medical care. If women are concerned and require urgent medical advice, they are

encouraged to call the maternity triage unit in the first instance. If attendance at the maternity unit or hospital is advised, pregnant women are requested to travel by private transport and alert the maternity triage reception once on the premises, prior to entering the hospital.

 

Diagnosis of COVID-19

The process of COVID-19 diagnosis is changing rapidly. If diagnostic tests are advised, pregnant women should follow advice given, which should not be altered based on pregnancy status. In the UK, pregnant women should be investigated and diagnosed as per local / Public Health England criteria.

References

https://www.rcog.org.uk/globalassets/documents/guidelines/coronavirus-covid-19-virus-infection-in-pregnancy-2020-03-09.pdf

https://www.nhs.uk/conditions/coronavirus-covid-19/

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