How does coronavirus (COVID-19) affect pregnant women?

On March 17 the SEGO (Spanish Society of Gynecology and Obstetrics) sent to all of its associates the Technical Document for the Management of pregnant women and newborns with COVID-19.

They are, it warned, recommendations being reviewed continuously, subject to modification if the epidemiological situation and the therapeutic options require it. The document stated the following:

• Management of a COVID-19 case requires a multidisciplinary approach that includes obstetricians, a neonatology team, anesthesia, and midwives.
• There are few available cases of pregnant women affected by COVID-19, but it seems that they are not more susceptible to becoming infected with coronavirus. In fact, this new virus seems to affect more men than women.
• Regarding vertical transmission (through the placenta): there is little evidence of this type of transmission (before, during or after delivery via breastfeeding) in women who acquire the infection during the third trimester of pregnancy.
• And in terms of horizontal transmission (by drops or by contact), usually through an infected close relative, it is the same as in the general population.
• There is no specific treatment against COVID-19. Based on previous experience with outbreaks by other coronaviruses, treatment with a combination of protease inhibitors (lopinavir / ritonavir) with or without interferon ? or ?, or treatment with a RNA polymerase (remdesivir) is being used experimentally in certain cases.
• As in the rest of the population, the same and well-known principles of treatment are outlined for pregnant women:

1. Early isolation measures.
2. Control of infection.
3. Sampling for the diagnosis of COVID-19
4. Oxygen therapy if necessary
5. Avoid fluid overload
6. Empirical antibiotic therapy if bacterial super infection is suspected
7. Monitoring of uterine dynamics and fetal well-being
8. Early mechanical ventilation in case of deterioration of respiratory function
9. Individualize the most appropriate time of delivery

The route and time of completion of labor should be assessed individually and multidisciplinarily. The decision of vaginal delivery or caesarean section must be evaluated taking into account first the obstetric criteria. But in severe cases, the termination of the pregnancy should be considered depending on the clinical state of the mother at that time. In these cases, it is recommended that delivery be carried out in a designated isolation room or in a delivery room intended for this purpose.

At the moment there is insufficient data to make a firm recommendation on breastfeeding in the case of infected women, although it is stressed that it could provide benefits such as the passage of antibodies from mother to child. Therefore, breastfeeding from birth is recommended, whenever the clinical conditions of the newborn and the mother allow.

Recommendations to pregnant women:

During pregnancy:

• Frequent hand washing.
• When coughing or sneezing, cover your nose and mouth with a flexed elbow.
• Avoid touching the eyes, nose and mouth since the hands facilitate the transmission.
• Use disposable tissues to eliminate respiratory secretions and throw away after use.
• Avoid crowds and public transport.
• Limit social relations.
• Limit trips to those strictly necessary.

Recommendations during the puerperium:

• Frequent hand washing
• When coughing or sneezing, cover your nose and mouth with your elbow flexed
• Avoid touching your eyes, nose and mouth
• Use disposable tissues to eliminate respiratory secretions and throw away after use
• Avoid crowds and public transport
• Limit social interactions
• Limit travel
• Limit hospital and home visits during the epidemic

In case of symptoms, self-isolate at home and contact the health services by telephone according to the recommendations in effect by your local government.