Black and Latina women were underrepresented in the PRIORITY study population as compared with previous assessments of the racial/ethnic distribution of SARS-CoV-2 infection in the U.S., highlighting a key limitation of the study (Flaherman, 2020). For additional information, see ACOG Committee Opinion 518, Intimate Partner Violence. Examples may include (but are not limited to) a pregnant patient with a history of solid organ transplant or someone with advanced vascular disease related to other comorbidities such as type 1 diabetes mellitus. SMFM members are also invited to join our new online community dedicated to COVID-19. To the extent possible, patients should be connected to community support resources. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. In Europe, decreases in rates of preterm delivery have been reported along with increased number of stillbirths, but initial evidence in the United States suggests preterm delivery and stillbirth rates are unchanged (Handley 2020; Hedermann 2020; Kahlil 2020). The Drug Enforcement Administration has released guidance allowing health care clinicians registered by the administration to issue prescriptions for controlled substances without an in-person medical evaluation for the duration of the public health emergency (see specific guidelines here). If pregnant workers cannot work because of health and safety risks, the law stipulates they should be suspended on full pay. Test-based strategy. It is important to recognize that strategies for resuming care will need to be developed on an individualized basis at the local, state, and regional level as national, regional, and local regulations and circumstances will influence the pace of, and approach to, resuming aspects of routine women’s health care. Guidance for contacts of people with confirmed coronavirus (COVID-19) … Because of the possible additive effect of the increased risk of thrombosis from COVID-19 infection and the hypercoagulative state of pregnancy, it may be prudent to consider this increased likelihood of clotting before administering TXA for postpartum hemorrhage. COVID-19 resources on coagulation and anticoagulation (International Society on Thrombosis and Haemostasis) Importantly, any determination of whether to keep individuals with known or suspected SARS-CoV-2 infection and their infants together or separate after birth should include a process of shared decision-making with the patient, their family, and the clinical team. If, after screening, the patient reports symptoms of or exposure to a person with COVID-19, that patient should be instructed not to come to the health care facility for their appointment and health care clinicians should contact the local or state health department to report the patient as a possible person under investigation (PUI). Patients who are discharged home for required isolation or who are treated as outpatients with a diagnosis of COVID-19 should follow discontinuation of isolation precautions guidance from the CDC. CMS strongly encourages maximizing the use of all telehealth modalities. Facility-level factors may influence the decision to transfer a patient to a higher level of care. One of the symptoms of COVID-19 is fever (high temperature). Last updated September 2, 2020 at 10:22 a.m. EST. The Department of Health and Human Services Office for Civil Rights has announced that it will exercise enforcement discretion and waive penalties for HIPAA violations against health care clinicians who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. Counsel patients that although the absolute risk for severe COVID-19 is low, available data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support (ECMO), and death reported in pregnant women with symptomatic COVID-19 infection. Although evidence is limited regarding the safety and efficacy of these approaches, ACOG recognizes the need to implement innovative strategies during this rapidly evolving public health emergency, with consideration of differences in care settings and population risks. Editor's Note: The information published in this story is accurate at the time of publication. Given the growing evidence, CDC now includes pregnant women in its “increased risk” category for COVID-19 illness. Can I work with patients who are potentially infected with COVID-19? Last updated May 13, 2020 at 2:57 p.m. EST. SMFM has developed resources to support the work of OB care providers and their patients during the global pandemic. Should new literature indicate any need for additional antenatal fetal surveillance for pregnant patients with suspected or confirmed COVID-19, ACOG will update our recommendations accordingly. Last updated August 20, 2020 at 10:21 a.m. EST. Jeanne Sheffield, M.D., an expert in maternal-fetal medicine at Johns Hopkins, explains what pregnant women should know about the impact of the coronavirus and COVID-19 on pregnancy. Facilities should have a plan for the care of individuals who decline COVID-19 testing. Finally, pregnant women should do the same things as the general public to avoid infection. Importantly, analyses so far are limited by a large amount of missing data. Decision-making around rooming-in or separation should be free of any coercion, and facilities should implement policies that protect an individual’s informed decision. | Terms and Conditions of Use. This issue should be raised during prenatal care and continue through the intrapartum period. Importantly, analyses so far are limited by a large amount of missing data. Last updated July 27, 2020 at 11:23 a.m. EST. Even if an individual is screened during pregnancy, additional screening also should occur during the postpartum period (Committee Opinion 757). Last updated May 1, 2020 at 8:50 a.m. EST. She provides perspective on current research data concerning pregnant women who have had COVID-19, and offers suggestions on what you can do to stay safer. It should be emphasized that patients can decompensate after several days of apparently mild illness, and thus should be instructed to call or be seen for care if symptoms, particularly shortness of breath, worsen. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Patients: Please refer to this page for information on coronavirus, pregnancy, and breastfeeding. A facemask for source control does not replace the need to wear an N95 or higher-level respirator (or other recommended PPE) when indicated (see. Pregnant women do not appear to be at higher risk of severe disease related to COVID-19. Test characteristics. If universal testing is being considered for a labor and delivery unit, testing capacity must include the ability to provide rapid results (eg, up to a few hours) in order to affect care during labor. A facemask instead of a cloth face covering should be used by these HCPs for source control during this time period while in the facility. Last update July 27, 2020 at 11:35 a.m. EST. COVID-19: Pregnancy, Breastfeeding & Infants. ACOG recommends all individuals older than two years of age wear a mask or cloth face covering in public and when around people outside of the household, especially in settings where other social distancing measures are not feasible. COVID-19 and VTE/Anticoagulation: Frequently Asked Questions. Monitor the impact of your decisions. Importantly, analyses so far are limited by a large amount of missing data. COVID-19 and VTE/Anticoagulation: Frequently Asked Questions If you have a high temperature and you are pregnant, phone your GP or midwife. Even during a shortage, it is important that medical staff use appropriate forms of PPE, including surgical masks. For patients with suspected or confirmed COVID-19 for whom low-dose aspirin would be indicated, modifications to care may be individualized. A test-based strategy is no longer recommended (except as noted below) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious. As part of evaluation, clinicians are strongly encouraged to test for other causes of respiratory illness and peripartum fever. What are the ethical considerations associated with caring for patients during the COVID-19 pandemic, including in the absence of adequate PPE? Mother using a mask or cloth face covering and practicing. Obstetrician-gynecologists and other maternal health care clinicians should: It should be noted that it may be necessary to provide these services or other enhanced resources by phone or electronically where possible. Checking with their pediatric clinician or family physician regarding newborn visits because pediatric clinicians or family physicians also may be altering their procedures and routine appointments (. For pregnant women the coronavirus crisis can be particularly daunting. Additionally, if not already doing so, facilities are encouraged to find innovative ways to collaborate with family physicians, midwives who are certified by the American Midwifery Certification Board (or its predecessor organizations) or whose education and licensure meet the International Confederation of Midwives Global Standards for Midwifery Education, and other obstetric care professionals. Additional key resources include: Last updated May 13, 2020 at 3:00 p.m. EST. Last updated December 14, 2020 at 2:03 p.m. EST. Here's what the doctors know and don't know yet. If there are shortages of gowns, they should be prioritized for: Care activities where splashes and sprays are anticipated. With insufficient information currently available regarding the physiologic safety of inhaled nitrous oxide in individuals with suspected or confirmed COVID-19, labor and delivery units may consider suspending use of nitrous oxide for individuals with suspected or confirmed COVID-19 or individuals with unconfirmed COVID-19 negative status. Although the absolute risk for severe COVID-19 is low, these data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support (ECMO), and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women (Zambrano MMWR 2020). She provides perspective on current research data concerning pregnant women who have had COVID-19, and offers suggestions on what you can do to stay safer. Last updated July 27, 2020 at 5:24 p.m. EST. When and how to contact their postpartum care clinician. Fever is the most commonly reported sign; most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (cough, difficulty breathing). During the H1N1 influenza pandemic, pregnant women made up 5% of deaths, despite only making up 1% of the population and pregnancy risk of ICU admission was reported as high as a 7-fold increase (Rasmussen 2012; Mosby 2011). If doulas are considered by the facility to be health care personnel, they should adhere to infection prevention and control recommendations, including the correct and consistent use of proper personal protective equipment. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. Ideally, all methods of contraception should be discussed in context of how provision of contraception may change within the limitations of decreased postpartum in-person visits. The majority of pregnant patients with COVID-19 will not meet this criterion. Engineering controls such as using physical barriers (eg, placing the neonate in a temperature-controlled isolette) and keeping the neonate 6 feet or more away from the mother as often as possible. Pregnant healthcare workers should follow CDC guidelines on risk assessment and infection control for healthcare workers exposed to patients with known or suspected COVID-19. When a pregnant patient with suspected or confirmed COVID-19 is admitted and birth is anticipated, the obstetric, pediatric or family medicine, and anesthesia teams should be notified in order to facilitate care. The Centers for Disease Control and Prevention (CDC) provides additional suggested guidance for managing visitors in inpatient obstetric health care settings. Alternate or reduced prenatal care schedules. However, given that pregnancy itself is now identified as a risk factor for certain outcomes, the magnitude of further increase from such comorbidities will need to be further delineated. Use of alternative mechanisms for patient and visitor interactions, such as video-call applications, can be encouraged for any additional support persons. Importantly, the correct and comprehensive use of recommended PPE, alongside hand hygiene and environmental cleaning, leads to the optimal decreased risk of transmission of respiratory viruses; and this is likely true for COVID-19. 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