Counseling in maternal-fetal medicine: SARS-CoV-2 infection in pregnancy

D Di Mascio, D Buca, V Berghella, A Khalil, G Rizzo, A Odibo, G Saccone, A Galindo, M Liberati, F D'Antonio
Ultrasound in Obstetrics & Gynecology 2021 March 16
SARS-CoV-2 is a zoonotic Coronavirus that crossed species to infect humans, causing a disease called COVID-19. Despite a potentially higher risk of acquiring SARS-CoV-2 infection compared to the non-pregnant population, no additional specific recommendations to avoid exposure are needed in pregnancy. Fever, cough, lymphopenia and raised C reactive protein levels are the most common clinical symptoms and laboratory signs of SARS-CoV-2 infection in pregnancy. Pregnancy carries a higher risk of severe SARS-CoV-2 infection compared to the non-pregnant population, including pneumonia, admission to ICU and death, mostly after adjusting for potential risk factors for severe outcomes. The risk of miscarriage does not appear to be increased in women with SARS-CoV-2. Evidence is conflicting when focusing on PTB and perinatal mortality, but these risks are generally higher only in symptomatic, hospitalized women. The risk of vertical transmission, defined as the transmission of SARS-CoV-2 from the mother to the fetus or the newborn, is generally low. Fetal invasive procedures are generally safe in women with SARS-CoV-2 infection although the evidence is still limited. Steroids should not be avoided if clinically indicated, preferring dexamethasone and then methylprednisolone for a total of 10-day course. NSAIDs might be used if there are no other contraindications. Pregnant women hospitalized with severe course of SARS-CoV-2 disease should undergo prophylactic thromboprophylaxis throughout the time of hospitalization and at least until discharge, preferably LMWH. Hospitalized women who have recovered from a period of serious or critical illness with COVID-19 should be offered at least a fetal growth scan about 14 days after recovery from their illness. In asymptomatic or mildly symptomatic women tested positive for SARS-CoV-2 infection at full term (i.e. ≥39 weeks of gestation), induction of labor might be reasonable. To date, there is no clear consensus on a proper timing of delivery for critically ill women. In women with no or few symptoms, management of labor should follow routine, evidence-based guidelines. Regardless of COVID-19, mothers and infants should remain together, breastfeed, practice skin-to-skin contact and kangaroo mother care, and rooming-in day and night while applying necessary infection prevention and control measures. Due to the absence of long-term evidence-based data, the possibility of undergoing vaccination should be offered after an extensive counselling on both the potential risk of a severe course of the disease and the unknown risk of fetal exposure to the vaccine. This article is protected by copyright. All rights reserved.

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