RCOG
Coronavirus (COVID-19) Infection in pregnancy Version 5: Publised 28 March 2020
1.3 vertical transmission is probable
4.7.2 The use of entonox
There is no evidence that the use of Entonox is an aerosol-generating procedure (AGP).
Entonox should be used with a single-patient microbiological filter.
Coronavirus (COVID-19) Infection in pregnancy Version 5: Publised 28 March 2020
1.3 vertical transmission is probable
4.7.2 The use of entonox
There is no evidence that the use of Entonox is an aerosol-generating procedure (AGP).
Entonox should be used with a single-patient microbiological filter.
4.8.1 Hourly observation of respiratory rate
Young fit women can compensate for a deterioration in respiratory function and are able to maintain normal oxygen saturations before they then suddenly decompensate. So a rise in the respiratory rate, even if the saturations are normal, may indicate a deterioration in respiratory function and should be managed by starting or increasing oxygen.
4.8.1 The use of steriod for fetal lung maturation
There is no evidence to suggest that steroids for fetal lung maturation, when they would usually be offered, cause any harm in the context of COVID-19. Steroids should therefore be given when indicated, and certainly prior to 30 weeks, where even one dose may benefit the neonate.
4.9.2 Infant feeding
In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother or another care giver, should they be infected, should be discussed with the parents.
4.10.1 General advice for obstetric theatre
Departments should consider running dry-run simulation exercises to prepare staff, build confidence 30 and identify areas of concern to prepare for emergency transfers to the operating theatre.
The chances of requiring conversion to GA during a caesarean birth commenced under regional anaesthesia are small but increase in relation to the urgency of caesarean birth. In situations where there are risk factors that make conversion to GA more likely, the decision on what type of PPE to wear should be judged based on the individual circumstances.
RCOG
Information for pregnant women and their families
Birth companion
Yes, you should be encouraged to have a birth partner present with you during labour and birth. Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and well-being of women in childbirth.
If your birth partner has symptoms of coronavirus, they will not be allowed to go into the maternity suite, to safeguard the health of the woman, other women and babies, and the maternity staff supporting you.
A birth partner without symptoms may be able to attend your induction of labour where that is in a single room (e.g. on the maternity suite) but not if the induction takes place in a bay on a main ward, as it would not be possible to achieve the necessary social distancing measures.
At the point you go into active labour, you will be moved to your own room and your birth partner will be able to join you.Labour companion during COVID-19
Hospital policy tracker regarding birth companion during COVID-19
WHO
Clinical management of severe acuterespiratory infection (SARI) when COVID-19disease is suspected. Interim guidance 13 March 2020, Page: 12 & 13
There is no evidence on mother-to-child transmission when infection manifest in the third trimester, based on negative samples from amniotic fluid, cord blood, vaginal discharge, neonatal throat swabs or breastmilk.
Mode of birth
WHO recommends that caesarean section should ideally only be undertaken when medically justified.
Infant feeding
Breastmilk samples from the mothers after the first lactation were also all negative for SARS-CoV-2.
The protective effect is particularly strong against infectious diseases that are prevented through both direct transfer of antibodies and other anti-infective factors and long-lasting transfer of immunological competence and memory.
Breastfeeding should be initiated within 1 hour of birth. Exclusive breastfeeding should continue for 6 months with timely introduction of adequate, safe and properly fed complementary foods at age 6 months, while continuing breastfeeding up to 2 years of age or beyond. Because there is a dose–response effect, in that earlier initiation of breastfeeding results in greater benefits, mothers who are not able to initiate breastfeeding during the first hour after delivery should still be supported to breastfeed as soon as they are able.
As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practising skin-to-skin contact or kangaroo mother care should practise respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if with respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces which the symptomatic mother has been in contact with.
Breastfeeding counselling, basic psychosocial support and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.
In situations when severe illness in a mother due to COVID-19 or other complications prevent her from caring for her infant or prevent her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant.
Mothers and infants should be enabled to remain together and practise skin-to-skin contact, kangaroo mother care and to remain together and to practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable or confirmed COVID-19 virus infection.
ACOG
Novel Coronavirus 2019 (COVID-19) Last updated April 23, 2020
Infant feeding
Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care professionals.
consider having someone who is not sick feed the expressed breast milk to the infant.
it is not yet known with a high level of confidence if COVID-19 can be transmitted through breast milk
CDC
Pregnancy and breastfeeding
In limited studies, COVID-19 has not been detected in breast milk; however we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk.
If you are sick and choose to direct breastfeed:
Wear a facemask and wash your hands before each feeding.
If the you are sick and choose to express breast milk
If possible, consider having someone who is well feed the expressed breast milk to the infant.
ISUOG
Interim guidance COVID-19
Novel coronavirus infection and pregnancy
Free Webinar
COVID-19: pregnancy, delivery and breastfeeding
A Chinese publication [1] describes the clinical features and histopathological examination of the placenta in 3 pregnant women with new Coronavirus infection, who delivered through caesarean section. The women, who had contracted the infection in the third trimester of pregnancy, were feverish without significant leukopenia and lymphopenia, one of them had developed viral pneumonia. The swabs for virus investigation were negative in the three newborns, and no vertical maternal-foetal transmission of the infection was detected. The histopathological examination of the placenta did not identify morphological changes related to the viral infection, and the investigation of the virus in the placental tissues was negative. The authors recommend an anatomopathological examination of the placenta and any abortion material in pregnant women with Covid-19 infection.
Treatment