General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

Stephens, Angela; Barton, John R.; Bentum, Nana-Ama Ankumah; Blackwell, Sean C.; Sibai, Baha M.

doi:10.1055/s-0040-1710308

Cited by 83 publications

(121 citation statements)

References 64 publications

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“…Given the observations of thromboses in the placenta, the known increased risks of venous thromboembolic disease in the postpartum period, the demonstrated coagulopathy associated with severe COVID-19, 15,16 women with COVID-19, even if asymptomatic, may be at increased risk for venous thromboembolic disease events, and prophylactic anticoagulation postpartum may also be warranted, consistent with other recommendations. 17,18…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study

Prabhu

Cagino

Matthews

et al. 2020

BJOG

258

256

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Objective To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). Design Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. Setting Three New York City hospitals. Population Pregnant women >20 weeks of gestation admitted for delivery. Methods Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. Main outcome measures Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. Results Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). Conclusion Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery.

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Section: Discussionmentioning

confidence: 99%

Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study

Prabhu

Cagino

Matthews

et al. 2020

BJOG

258

256

View full text Add to dashboard Cite

show abstract

“…Several publications have suggested steps to be taken to prevent horizontal transmission during neonatal resuscitation at delivery of COVID-19 positive mothers. [56][57][58] On that basis, AAP recommends to wear personal protective equipment including a gown, gloves, N95 respiratory mask, and eye protection goggles or an air-purifying respirator that provides eye protection while attending deliveries or conducting neonatal resuscitation for neonates born to COVID-19 positive mothers. 50 Delayed cord clamping has not been shown to transmit the virus as yet, and so it should be continued as per the unit policy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

2020

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Objective Novel coronavirus disease 2019 (COVID-19) seems to affect adults and pediatric patients differently. While neonates are a special population, little is known about the neonatal outcomes. This study aimed to investigate the outcomes in COVID-19 positive neonates and incidence of vertical transmission of the virus by reviewing available literature. Study Design This study is a narrative review of available literature on “COVID-19 in neonates,” for which PubMed and Google Scholar were used to search the published articles. Results We summarized the data from 39 published studies that are comprised of 326 COVID-19 positive peripartum mothers with respective neonatal outcomes. Twenty-three neonates have been reported to be COVID-19 positive. Male neonates were affected significantly more (79%) than female neonates. Approximately 3% neonates acquired infection through suspected vertical transmission. Strict infection prevention measures during the perinatal time can significantly reduce the chance of horizontal transmission of the virus. Overall, neonates were asymptomatic or mildly symptomatic regardless of gestational age at birth and required only supportive measures. There was 0% mortality in COVID-19 positive neonates. Conclusion From available published data to date, we can conclude that the prognosis of COVID-19 positive neonates is good with no mortality. There appears to be minimal vertical transmission of the infection. Key Points

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“…Several expert commentaries have provided guidance on PPE, procedures during L&D, and management of common obstetrical issues during the pandemic. [20][21][22] A recent Cochrane review aimed at compiling international guidelines related to COVID-19 during pregnancy. 23 This group found international consensus in a few important areas, including which pregnant women should wear a mask or respirator, and how centers were managing support persons in asymptomatic women.…”

Section: Resultsmentioning

confidence: 99%

A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic

et al. 2020

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Recently, a novel coronavirus, precisely severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), that causes the disease novel coronavirus disease 2019 (COVID-19) has been declared a worldwide pandemic. Over a million cases have been confirmed in the United States. As of May 5, 2020, New York State has had over 300,000 cases and 24,000 deaths with more than half of the cases and deaths occurring in New York City (NYC). Little is known, however, of how this virus impacts pregnancy. Given this lack of data and the risk for severe disease in this relatively immunocompromised population, further understanding of the obstetrical management of COVID-19, as well as hospital level preparation for its control, is crucial. Guidance has come from expert opinion, professional societies and public health agencies, but to date, there is no report on how obstetrical practices have adapted these recommendations to their local situations. We therefore developed an internet-based survey to elucidate the practices put into place to guide the care of obstetrical patients during the COVID-19 pandemic. We surveyed obstetrical leaders in four academic medical centers in NYC who were implementing and testing protocols at the height of the pandemic. We found that all sites made changes to their practices, and that there appeared to be agreement with screening and testing for COVID-19, as well as labor and delivery protocols, for SARS-CoV-2-positive patients. We found less consensus with respect to inpatient antepartum fetal surveillance. We hope that this experience is useful to other centers as they formulate their plans to face this pandemic. Key Points

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General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic

Cited by 83 publications

References 64 publications

Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study

Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic

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