It is a well-known fact that several viral infections have consequences for pregnant women. And the novel coronavirus is also a respiratory viral infection. Even though there is no confirmation from any of the experts that pregnant women are at a higher risk to contract the virus, they are expected to follow guidelines for pregnant women strictly. Pregnant women during coronavirus outbreak may be asymptomatic or have mild to moderate flu-like symptoms, often involving cough, fever, or shortness of breath.
However, pregnancy immune adaptation, particularly after 28 weeks of gestation in the third trimester, can result in more serious symptoms in a subset of females that can involve pneumonia or hypoxia, requiring a prompt medical response. Currently, there is no evidence indicating an elevated risk of fetal miscarriage, early pregnancy loss, second-trimester loss, or congenital defect. Nonetheless, Covid-19 positive women have recorded preterm births, but further studies are needed before any definitive associations can be established.
Following are the guidelines for pregnant women during coronavirus outbreak:
- Ante-natal and postnatal prenatal care should be given priority and must be scheduled between the pregnant woman and the doctor.
- Internet or telephone appointments can be used to minimize in-person visits.
- Urgent appointments (indications of fetal medication, high-risk births, etc.) must be individualized and checked by the obstetricians to ensure adequate care.
- According to recommendations, symptomatic pregnant women should be screened for Covid-19 and treated as sick before the test results indicate otherwise. In the case of serious Covid-19 symptoms in a pregnant woman, chest X-ray and chest CT scan should be conducted with abdominal shielding and should not be postponed due to fetal concerns.
- Staff must wear PPE during an obstetric emergency and separate the patient first from other pregnant women and then treat the obstetric emergency as a priority, without waiting for the Covid-19 check.
- Intrapartum treatment for women with actual or suspected labor-time Covid-19 will take place in isolation rooms with a multidisciplinary team strategy involving a specialist in medical or infectious diseases.
- Women with COVID-19 are allowed to breast-feed as long as they take proper precautions such as frequent hand-washing, avoiding coughing or sneezing while feeding, wearing face-mask, properly cleaning the breast-pumps before and after use, and preferably feed expressed milk.
Owing to uncertain effects on fertility and early pregnancy, the American Society for Reproductive Medicine (ASRM) advises elimination of all new stimulation cycles for in-vitro fertilization (IVF), as well as elective surgery and non-emergency diagnostic procedures. It advises IVF practices to consider for the time being firmly canceling both fresh and frozen embryo transfers. However, ongoing stimulation cycles, as well as patients that need urgent stimulation or cycles of cryopreservation due to cancer therapy, may be complete.
Obstetricians, gynecologists, and fertility specialists are expected to keep continuous monitoring of potential infection transmission and to be trained in infection control and prevention measures for pregnant women.