Management

The following suggestions apply to all hospital/clinic attendances for women with suspected or confirmed COVID-19. The advice below mostly refers to the care of women in the second or third trimesters of pregnancy. Care of women in the first trimester should include attention to the same infection prevention and investigation/diagnostic guidance for non-pregnant adults. 

General advice for services providing care to women with suspected or confirmed COVID-19

• Women should be advised to attend via private transport where possible or call 111/999 for advice as appropriate. If an ambulance is required, the call handler should be informed that the woman is currently in self-isolation for possible COVID-19.
• Women should be asked to alert a member of maternity staff to their attendance when on the hospital premises, but prior to entering the hospital.
• Staff providing care should take personal protective equipment (PPE) precautions as per local/Public Health England/Health Protection Scotland guidance.
• Women should be met at the maternity unit entrance by staff wearing appropriate PPE and provided with a surgical face mask (not a FFP3 mask). The face mask should not be removed until the woman is isolated in a suitable room.
• Women should immediately be escorted to an isolation room, suitable for the majority of care during their hospital visit or stay. For overnight stays, isolation rooms should ideally have an antechamber for the donning and removing of staff PPE equipment, and en suite bathroom facilities. Radiographic investigations should be performed, as for the non-pregnant adult; this includes both an X-ray and CT scan of the chest. Reasonable efforts to protect the fetus from radioactive exposure should be made, as per usual protocols.
• Chest imaging, especially CT chest, is essential for the evaluation of the unwell patient with COVID-19 and should be performed when indicated, and not delayed due to fetal concerns.
• Rooms should have negative pressure in comparison to the surrounding area, if available.
• Only essential staff should enter the room, and visitors should be kept to a minimum.
• Remove non-essential items from the clinic/scan room prior to consultation.
• All clinical areas used will need to be cleaned after use as per local/Public Health England/Health Protection Scotland guidance.
• Obstetricians should be familiar with local protocols for the initial investigation and care of patients presenting to medical teams with possible COVID-19. These protocols should be followed for pregnant women as far as possible (including initial investigations, management of fluid balance and escalation of care to involve the critical care team).
• The priority for medical care should be to stabilise the woman’s condition with standard therapies.
• An MDT planning meeting should be urgently arranged for any unwell woman with suspected/confirmed COVID-19. This should ideally involve a consultant physician, consultant obstetrician, midwife-in-charge, consultant neonatologist, consultant anaesthetist and intensivist responsible for obstetric care.
• If there is clinical uncertainty in whether to offer a therapy to a pregnant woman, seek advice through maternal medicine networks.
• Women with moderate-to-severe symptoms of COVID-19 should be monitored using hourly fluid input/output charts.

See the flow chart to assess COVID-19 risk in maternity unit attendees below for full information on how to assess and manage various cases.

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General advice for services providing care to all women

• Antenatal and postnatal care should be regarded as essential care and women should be encouraged to attend, despite being advised to otherwise engage with social distancing measures.
• Women should be advised to attend routine antenatal care unless they meet current self-isolation guidance for individuals and households of individuals with symptoms of new continuous cough or fever.
• Those providing care should adhere to guidelines for safely reintroducing measures which enable partners to attend antenatal and postnatal appointments, including pregnancy scans (RCOG, RCM, SCoR, NHS; 2020).
• Units should rapidly seek to adopt teleconferencing and videoconferencing capability and consider what appointments can be conducted remotely. Further guidance is available from the RCM and RCOG on antenatal and postnatal consultations which are appropriate to be provided remotely.
• Data from UKOSS and the Office for National Statistics suggest that individuals of BAME background are at higher risk of hospitalisation and/or death with COVID-19. We therefore advise:
  • women of BAME background should be opportunistically advised that they may be at higher risk of complications of COVID-19, and advised to seek help early if they are concerned about their health
  • clinicians should be aware of this increased risk, and have a lower threshold to review, admit and consider multidisciplinary escalation in women of BAME background.