Guidelines for COVID – 19 in Pregnancy

To date, there has been limited data on the infection rate and evolution of the COVID – 19 virus in expectant women. This means that healthcare practitioners are limited in their ability to make recommendations on how to handle a pregnant lady infected with coronavirus.

The last time that the profession has had to address a public health concern such as this was during the outbreak of the Zika virus in Latin America in 2015. The Zika virus generated widespread media notoriety because of its significant morbidity. It led to poor pregnancy outcomes such as miscarriages still births and premature births while causing serious congenital defects such as microcephaly (small head) in babies born to infected mothers.

For the novel coronavirus, scientists are yet to establish the net effect on pregnancy given that the disease was first discovered in September 2019 and we are yet to go through a full nine month cycle at the time of publishing of this article.

However, pending a local solution, the Swiss Society of Gynecology and Obstetrics has developed a guideline to help clinicians manage cases of coronavirus in pregancy.
The algorithm and guidelines, both published in The Lancet Infectious Diseases, will be updated as new data emerges. The highlights of the guidelines include:

– A pregnant woman who has traveled in a country affected by COVID – 19 in the past 14 days or who has had close contact with an individual with confirmed infection should be tested with a PCR test, even if asymptomatic.

– Asymptomatic pregnant women with laboratory-confirmed COVID – 19 infection should self-monitor in isolation for at least 14 days; these women and those recovering from mild illness should be monitored with bimonthly fetal growth ultrasounds and Doppler assessments.

– Pregnant women with COVID-19 pneumonia should be managed by a multidisciplinary team at a Level 5 care center.

– For pregnant women with confirmed infection, delivery timing should be individualized depending on the week of gestation and maternal, fetal, and delivery conditions. Whenever possible, vaginal delivery via induction of labor, with eventual instrumental delivery to avoid maternal exhaustion, is preferred.

– Newborns of mothers positive for COVID – 19 should be isolated for at least 14 days or until viral shedding clears; direct breastfeeding is not recommended during this time.

It is important to note that this information is on the basis of currently available data which is limited. Further recommendations should be adapted to local context and in response to further updates on COVID – 19.

SOURCE: and The Lancet Infectious Diseases, online March 3, 2020.

Dr Noah Akala, MD

Public Health Specialist.

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