Algorithm for Pregnancy and COVID-19
Posted May 12, 2020
Historically, pregnant women have been considered at increased risk of infectious respiratory diseases, as observed during the last H1N1 infection epidemic.
“Nowadays, with the COVID-19 pandemic, the prevalence of complications or mortality does not seem to be higher in this group, although data are still very scarce,” explained Prof. Dr. Rui Alberto Ferriani, deputy coordinator of Instituto Hormona.
He explains that intrauterine vertical transmission from mother to newborn does not seem to occur and that, during breastfeeding, the main route of contamination may be through mother’s breathing rather than through breast milk.
Monitoring of Medical Literature
Investigations have demonstrated that COVID-19 clinical presentations vary greatly and, thus, it will take more time to understand the possible repercussions of this disease during the gestational-puerperal cycle. According to Dr. Ferriani, a continuous monitoring of medical literature is required, since it has presented case reports, or series of a limited number of cases, building a body of evidence to better assess practical conducts regarding this population.
Algorithms are used to assist the medical population in decision-making during the follow up of either asymptomatic or symptomatic patients. “Therefore, at a healthcare service, there may be patients with symptoms suggesting COVID-19, completely asymptomatic patients, and those under investigation due to increased risk of contamination because they had contact with a COVID-19 patient or had travelled to a highly infected region,” explained Dr. Ferriani.
Measures to be taken include initial clinical assessment, followed by testing in order to classify patients into care and isolation protocols compatible with the safety of pregnant women, the health care team, and newborns.
Information obtained from the above procedures assists and streamlines healthcare provision, because it quickly provides decision-making indicators. “And, nowadays, we expect these algorithms to change as scientific data emerge.”
“There are general care recommendations to be followed during hospitalization, during childbirth, or during and after childbirth, and always including every patient at the end stage of pregnancy into higher- or lower-risk groups.”
He reports that at least two algorithms were recently published and provide guidelines to the health care team, the first of which on March 3rd by Favre and cols – http://dx.doi.org/10.1016/S1473-3099(20)30157-2 -, and the other on April 10th, 2020 by the American College of Obstetricians and Gynecologists (ACOG), with the latter being endorsed by the CDC and the NIH – https://covid19treatmentguidelines.nih.gov/.