Corona Virus — Pregnancy related questions answered

In the light of Corona pandemic Royal College Obstetrician and Gynecologist has published a document addressing all issues relevant to pregnancy(effect of corona on unborn baby/ after delivery/ effect

In the light of Corona pandemic Royal College Obstetrician and Gynecologist has published a document addressing all issues relevant to pregnancy(effect of corona on unborn baby/ after delivery/ effect on new born /prevention / once exposed to corona virus what measures to be taken/ what is self isolation/ can I attend my antenatal appointment/ will it affect where I give birth/ will it affect how I give birth. )

Pregnant women do not appear to be more severely unwell if they develop coronavirus than the general population. As this is a new virus, how it may affect you is not yet clear. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions. In pregnancy if you have any underlying illness such as asthma/COPD/ hypertension / heart condition you are at risk and you should take all caution to reduce risk of infection.

In pregnancy effect on unborn baby based on limited evidence is increased risk of growth restriction and risk of prematurity (mainly iatrogenic). There is no evidence to suggest corona virus is transmitted to baby. At present Caesarean section is not a safer option for delivery. Choice of birth options should be discussed with your health provider. Place of birth for patients with suspected corona virus or infected patient should be delivered in high risk obstetric unit (where facilities of High dependency unit and intensive care unit is available) or designated units.

Cautions to reduce risk-

Follow WHO guidance-

Avoid public gatherings/ work from home if possible. Avoid public transport if not necessary.

To protect yourself and other people:

• wash your hands with soap and water often — do this for at least 20 seconds
• always wash your hands when you get home or into work
• use hand sanitizer gel if soap and water are not available
• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin straight away and wash your hands afterwards
• try to avoid close contact with people who are unwell
• do not touch your eyes, nose or mouth if your hands are not clean

As this is a new virus, there is limited evidence about managing women with coronavirus infection in women who have just given birth; Consider wearing a face mask while breastfeeding. If you choose to feed your baby with formula or expressed milk then adhere strictly to sterilization guidelines.

Dr Rachana Choudhary, Second Medic Inc

MBBS, FRCOG, FICOG, PGC ( USS), DFFP

Consultant Obstetrics & Gynecology

Royal Bournemouth & Christchurch Hospital

COVID-19 Virus Infection and Pregnancy

Information for pregnant women and their families

Q1. What effect does coronavirus have on pregnant women?

It doesn’t increase risk of miscarriage, based on current evidence there is possibility of growth restriction and risk of prematurity. Pregnant women do not appear to be more severely unwell if they develop coronavirus than the general population. As this is a new virus, how it may affect you is not yet clear. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions. There are no reported deaths of pregnant women from coronavirus at the moment.

If you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus.

Q2. What effect will coronavirus have on my baby if I am diagnosed with the infection?

If you have infection there is a risk of transmitting to the baby because of close proximity, it is advisable to use mask during breast feeding and wash hands before and after contact.

As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage. There is also no evidence that the virus can pass to your developing baby while you are pregnant (this is called vertical transmission). It is therefore considered unlikely that if you have the virus it will cause abnormalities in your baby.

Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused this or the doctors made the decision for the baby to be born early because the woman was unwell. As we learn about the risk of pre-term birth and coronavirus infection, we will update this information.

Q3. What can I do to reduce my risk of catching coronavirus?

The most important thing to do is to wash your hands regularly and effectively as soon as you come from public places to your home or workplace. The best way to reduce any infection risk, not just for coronavirus, but for other things like colds and flu.

Q4. What is the travel advice if I am pregnant?

In pregnancy and knowing the risk of Risk of Corona virus travelling should be avoided. If you have to travel in emergency Air travel, then take necessary precautions.

Q5. What should I do if I think I may have coronavirus or been exposed?

If you are pregnant and you have either:

• a high temperature
• a new, continuous cough

You should stay at home for 7 days. Do not go to a GP surgery, pharmacy or hospital.

You should contact the maternity unit looking after your pregnancy to inform them that you have symptoms suggestive of coronavirus, particularly if you have any routine appointments in the next 7 days.

You should get medical assistance if:

• you feel you cannot cope with your symptoms at home
• your condition gets worse
• your symptoms do not get better after 7 days
• If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife, or out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

Q6. How will I be tested for coronavirus?

The process for diagnosing coronavirus infection is changing rapidly. At the current time, only people with severe symptoms who require overnight admission to hospital will be tested.

If you do require a test, you will be tested in the same way as anyone being tested, regardless of the fact that you are pregnant. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, a mixture of saliva and mucous.

Q7. What should I do if I test positive for coronavirus?

If you test positive for coronavirus, you should contact your midwife or antenatal team to make them aware of your diagnosis. If you have no symptoms, or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in a hospital setting.

Q8. Why would I be asked to self-isolate?

You may be advised to self-isolate because:

• You have symptoms of coronavirus, such as a high temperature or new, continuous cough
• You have tested positive for coronavirus and you’ve been advised to recover at home

Q9. What should I do if I’m asked to self-isolate?

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 7 days. The guidance on self-isolation currently recommends people should:

• Not go to school, work, NHS settings or public areas
• Not use public transport
• Stay at home and not allow visitors
• Ventilate the rooms where they are by opening a window
• Separate themselves from other members of their household as far as possible, using their own towels, crockery and utensils and eating at different times
• Use friends, family or delivery services to run errands, but advise them to leave items outside.

You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates.

Q10. Can I still attend my antenatal appointments if I am in self-isolation?

You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and request advice on attending routine antenatal appointments.

It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect other patients.

Q11.How will my care be managed after I have recovered from coronavirus?

If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged 14 days after your recovery, to check that your baby is well. This 14-day period may be reduced as more information on how infected people are in recovery becomes available.

If you have recovered from coronavirus and tested negative for the virus before you go into labour, where and how you give birth will not be affected by your previous illness.

Q12. What do I do if I feel unwell or I’m worried about my baby during self-isolation?

Pregnant women are advised not to attend maternity triage units or A&E unless in need of urgent pregnancy or medical care.

If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife, or out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

If attendance at the maternity unit or hospital is advised, pregnant women are requested to travel by private transport, or arrange hospital transport, and alert the maternity triage reception once on the premises, prior to entering the hospital.

Q13. Will being in self-isolation for suspected or confirmed coronavirus affect where I give birth?

As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour, are being advised to attend an obstetric unit for birth, where the baby can be monitored using continuous electronic fetal monitoring, and your oxygen levels can be monitored hourly.

The continuous fetal monitoring is to check how your baby is coping with labour. As continuous fetal monitoring can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife led unit, where only midwifes would be present.

We will keep this advice continually updated as new evidence emerges.

Q14. Will being in self-isolation for suspected or confirmed coronavirus affect how I give birth?

There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth plan should be followed as closely as possible based on your wishes.

However, if your respiratory condition (breathing) suggested that urgent delivery would be needed, a caesarean birth may be recommended.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. However, the use of Entonox (gas and air) may increase aerosolisation and spread of the virus, so your maternity team will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you.

Q15. What happens if I go into labour during my self-isolation period?

If you go into labour, you should call your maternity unit for advice, and inform them that you have suspected or confirmed coronavirus infection.

If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as per standard practice.

Your maternity team have been advised on ways to ensure you and your baby receive safe, quality care, respecting your birth plan as closely as possible.

When you and your maternity team decide you need to attend the maternity unit, general recommendations about hospital attendance will apply:

• You will be advised to attend hospital for advice as appropriate
• You will be met at the maternity unit entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room
• Coronavirus testing will be arranged
• Your birth partner(s) will be able to stay with you throughout, but visitors should be kept to a minimum

Q16. Could I pass coronavirus to my baby?

As this is a new virus, there is limited evidence about managing women with coronavirus infection in women who have just given birth; however, there are no reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.

Q17. Will my baby be tested for coronavirus?

Yes, if you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.

Q18. Will I be able to stay with my baby/give skin-to-skin if I have suspected or confirmed coronavirus?

Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth.

There are some reports from China which suggest women with confirmed coronavirus have been advised to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding.

A discussion about the risks and benefits should take place between you and your family and the doctors caring for your baby (neonatologists) to individualize care for your baby.

This guidance may change as knowledge evolves.

Q19. Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognized benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.

The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team.

This guidance may change as knowledge evolves.

If you choose to breastfeed your baby, the following precautions are recommended:

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

If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilization guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

Q20. What is the advice if I am a healthcare worker and pregnant?

We understand that it must be an anxious time if you work in healthcare and you are pregnant. To the best of our knowledge, pregnant healthcare professionals are no more personally susceptible to the virus or its complications than their non-pregnant colleagues.

However, infection with coronavirus may pose some risks to your unborn baby. There is a possible risk of fetal growth restriction, or of premature birth if you become seriously unwell.

You should discuss your individual circumstances your local Occupational Health depart