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Dealing with Covid-19 In Pregnancy (RCOG guidelines)

With the onset of the global pandemic, we now have to consider new, safe ways for dealing with Covid-19 in Pregnancy. This includes what (and what not) to do when pregnant. These measures or guidelines are essential in order to prevent possible serious illness for both you and your baby while we still await treatment or prevention methods.

Dealing with Covid-19 in Pregnancy - man kissing abdomen of is pregnant wife
Photo by Freddy G on Unsplash

At present, social distancing, hand hygiene and face coverings still remain our best prevention measures. These are in addition to observing self isolation when infected or exposed and robust testing systems that allow you have prompt access to Covid-19 tests if necessary.

Below, we share common questions you may find useful to support your health care.

A review of the RCOG guideline on March 13, 2020.

When reading/viewing any information about Coronavirus, one of the important things to consider is the date, because the situation is fluid and new information is emerging daily about the virus.

In addition to other special groups, pregnant women are understandably concerned about the effect of the virus on their babies and themselves.

Based on the limited factual data we have, the RCOG (Royal College of Obstetricians and Gynaecologists) has issued some guidelines on how to remain well around Covid-19 in Pregnancy,

We address these in the questions and answers below:


Q1 - I'm 28 weeks. Could the coronavirus affect me or my baby?

First, as a pregnant woman, you have a slightly increased risk of picking up infections - viral, bacterial etc generally.

This means being pregnant and because of changes to your immune system you are generally more susceptible to developing infections than others in the community.

So far, however there is no evidence that a woman is more at risk of contracting this particular SARS-CoV-2 virus simply because she is pregnant.

But the information has limits and is evolving.

There is a risk of contracting the virus when you are pregnant if following exposure to a positive case or where there are high numbers in your community.

The way to reduce the risk is by practising the same protective advice as the rest of the population in addition to your local area/state or country guidelines.

  • Washing hands for at least 20secs frequently and regularly/hand sanitiser
  • Avoid touching your face
  • Keep a distance of 3 steps/2 meters when possible from anyone who appears to have symptoms - cough, fever or sore throat.
  • After handling objects in public areas like money, post, shopping basket/trollies, clean your hands promptly.
  • Avoid large gatherings of people.

And what about your baby?

So far, we do not have any conclusive evidence that the coronavirus passes from the Mum to the baby through the placenta; or as baby advances through the birth canal in labour or from breastfeeding, that is, from vertical transmission.

There is no evidence from the studies on pregnant women that novel coronavirus can lead to miscarriage either.

From the studies of Covid-19 in pregnancy we have to date, some of their babies were born prematurely.

However, we do not know whether it was the infection that resulted in the premature birth; or whether doctors decided to intervene early as the mother was unwell.

Please remember that what we know about the SARS-CoV-2 virus remains limited and every other day we discover something new.


Q2 - Can I still deliver my baby vaginally if I have coronavirus? Or is C-section compulsory?

The studies we have indicate that when a woman goes into labour, it is important to monitor the baby continuously.

It is thus preferable if you test positive with Covid-19 to have your baby in hospital.

The type of birth delivery may depend on a number of things:

  • How mild or severe are the mother's symptoms?
    • If mild, a vaginal birth may still occur - taking into account the baby's condition.
    • If mum's symptoms are severe, then there may be a need for urgent delivery of the baby

  • What is the baby's condition?
    • Through continuous monitoring, we can detect quickly features of distress to the baby - which may mean a C-section delivery.

  • Does mum have previous medical problems that may increase the strain on her if she tries to deliver vaginally?

So these are some of the considerations around the mode of delivery for the mum and baby.

(Read about reasons for having a C-section here.)

Presently there is NO fixed rule on having a C-section because one is Covid-19 positive, but clinicians should have a discussion with the woman and her partner, prepare and be ready to convert a vaginal delivery into a C-section if that becomes necessary.

Finally: WHO recommends that "caesarean section should ideally be undertaken only when medically justified".


Q3- My husband has been diagnosed with Covid-19. I'm 33 weeks pregnant - what should I do?

In this situation, you have been in contact with a person who has Covid-19.

The possible outcomes are that you may become infected and develop symptoms, or you may become infected and show NO symptoms.

The possibility that you will not contract the virus is low.

Whichever the case, you will need to contact your own local health authority. The recommendations will likely include testing and isolation while exact proceedures can vary from place to place.

Some health authorities advice self-isolation; while others would arrange isolation within a medical facility.

If you require to self-isolate:

  • You should not go to school, work, clinics or any other public areas
  • Do not use public transport
  • Stay at home and do not allow visitors
  • Ventilate the rooms where you are by opening a window
  • Separate yourself from any other members of your household as far as possible
  • Use your own towels, crockery and utensils
  • Eat meals at different times from others at home
  • Use shared spaces like a bathroom or kitchen last and clean up afterwards
  • Use friends, family or delivery services to run errands, but advise them to leave items outside.

(Read more about self-isolation here)

If you develop severe symptoms such as breathing difficulty, or pregnancy-related problems like pain or bleeding then we will see you to arrange any necessary tests and treatment.

Please do not panic.

From the available evidence to date, any deaths due to Covid-19 in pregnancy are still in low numbers.

There is also no evidence of transmission to the baby or complications to the baby from Covid-19 infection.

Self-isolating and keeping track of your symptoms, resting and keeping well hydrated are important measures to avoid any complications.


Q4- How can I reduce the risk of getting Covid-19 in Pregnancy?

If you are pregnant and living in an area of high risk, the precautions to take are the same as everyone else.

  • It's wise to avoid non-essential travel or movements.
  • You should maintain hand hygiene practice regularly and frequently in and outside the house.
  • Keep surfaces around the house clean.
  • Avoid touching the face.
  • Keep a distance of 2m or 3 steps away from persons who may appear to show signs of infection.
  • Keep your immune system up with healthy food - including fruits and vegetables.
    • Vitamin supplements like your prenatal vitamins will help avoid Vit C, D or Iron deficiencies.
  • Get enough rest, and when you can, some mild-moderate exercise of about 30mins for 5 days a week.


Q5- What should I do if I have symptoms of Covid-19? Can I get a vaccine?

It's important to say that many cases of Covid-19 are asymptomatic.

In a significant number of cases, there are symptoms - among the most common are fever, new persistent dry cough, and fatigue.

Others include headache, blocked nose, sore throat, feeling short of breath, muscle and joint aches, chills, nausea or vomiting and diarrhoea.

So, if during this period you develop one of these symptoms then you should contact your local health provider for advice.

Please recall that about 80% of cases with infections are mild, roughly 15% are severe, while around 5% reach critical status.

In many countries, you can use Apps, websites and special public health phone lines to get real time information and guidance.

You may also reach your primary care provider and general practitioners for initial advice.

Some countries recommend self-isolation for mild symptoms.

In other countries, dending on the health service capacity, if you test positive, isolation and care in special medical facilities are the norm. This may change if the facilities can only cope with severely ill people.

If you develop Covid-19 in pregnancy, the current advice if your symptoms are mild is to self-isolate.

If you start to feel worse, then arrangements can be made for you to be seen in a hospital setting.

Presently, we do not have a vaccine to offer pregnant women to prevent the condition.

The current thinking is that a vaccine may be available within the next 12-18 months.

Treatment will be based on your symptoms and is mainly supportive.

Image with symptoms of Coronavirus
Credit @florian_krammer, Twitter


Q6 - Could I pass coronavirus to my baby?

From the studies in China earlier in the year, we first believed there was no evidence of vertical transmission from mum to baby.

This means - transfer through the placenta or birth canal during labour.

Of course, this has changed as we do have reports of babies of Mums with Covid-19 in pregnancy who test positive at birth.

The truth is that so far, scientists are not 100% sure about all the ways that COVID-19 can spread in the general population.

What we know so far is that the virus can transfer from surfaces that people touch, and air droplets from coughing/talking/sneezing, etc.

We recently had a study showing how many hours the virus could survive in different surfaces air, cardboard, plastics, etc.

The virus is also present in stools or other body fluids like vomit emphasising the need for good hand hygiene - in pregnancy as well.

Early studies we have of women who delivered earlier in the year that were Covid-19 positive in the third trimester did not find signs of the virus in amniotic fluid, umbilical cord blood, breast milk and samples from the newborn's throat. 

But there are cases when the reverse is the case - babies testing positive at birth.

This guides the recommendation for all babies born to Mums who are Covid-19 positive to receive testing for the infection and continuous monitoring after birth.


Q7- If I have CoronaVirus could I be isolated from my baby after it's born?

There are issues over whether to isolate the newborn baby from a mum who is Covid -19 positive.

This was done in China when women with Covid-19 infections delivered and were isolated from their babies for 14 days.

This debate is over concerns to do with restricting feeding and bonding that could be detrimental to the baby and mum relationship.

The current advice would be for the clinicians to take into account mum's state of health, the baby's and the family's wishes to decide on separation to prevent potential infection to the baby.

Following the birth of a new baby (in London on 15th March 2020), who tested positive to COVID-19 shortly after birth, the baby was separated from the mum.

According to reports available to us - the mother was transferred to an infectious disease hospital for treatment after delivery.

Thus the decision should be taken on a case by case basis but everything possible must be done to ensure the baby's safety.


Q8 - Can I breastfeed my baby if I have symptoms of coronavirus?

Very cautiously, doctors think that Coronavirus is not transmitted in the breast milk.

This is as a result of the limited information and evidence we have currently.

The advice presently is that the benefits of breastfeeding are more than any potential risks of transmission of the virus through breastmilk.

Remember that normally breastfeeding is particularly effective against infectious diseases.

This is because it transfers antibodies and other important immune factors to the baby from mum.

It is thought that there is a potential risk when breastfeeding because of the infected droplets from the nose/mouth that can be passed from mum to baby when breastfeeding.

These concerns and the advantages of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with mum.

So for a woman who is Covid-19 positive who wishes to breastfeed, the RCOG gives this advice to limit viral spread:

  • Hand washing before touching the baby, breast pump or bottles;
  • Try and avoid coughing or sneezing on your baby while feeding at the breast
  • Consider wearing a face mask, if available, while breastfeeding
  • Follow the recommendations for pump cleaning after each use
  • Consider asking someone who is well to feed expressed milk to the baby


Have you any comments or observations about these guidelines? Have you recently found out you are pregnant - what concerns do you have?


More Reading:

Reference:

Coronavirus (Covid-19) infection in Pregnancy, RCOG Guidelines March 13 2020.

Information for Pregnant Women and Their Families

Newborn baby tests positive with Coronavirus in London.

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Edited by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

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