COVID-19 obstetric practice recommendations

Clinical recommendations about COVID-19 are quickly developing. The following guidance for obstetric providers supplements Centres for Disease Control and Prevention (CDC) recommendations.

• Pregnant women should be regularly screened for symptoms consistent with an upper respiratory infection; any symptom should result in testing of a nasopharyngeal swab for COVID-19.

• All women scheduled for induction or caesarean delivery and their support person should be screened for symptoms of COVID-19 24 to 48 hours before arrival at the hospital and rescreened prior to entry to labour and delivery. If the woman screens positive, induction and caesarean should be rescheduled if possible.

• All hospitalised women and their support person should be screened for symptoms daily. If the pregnant woman screens positive for symptoms, she should have a nucleic acid test for COVID-19; and if the support person screens positive, s/he should be sent home. If the nucleic acid tests were sufficiently available, the support person with symptoms of a viral upper respiratory infection would have such testing.

• For pregnant women with COVID-19, Betamethasone administration should be limited to those at high risk for preterm delivery within 7 days and only given between 23 weeks' and 33 weeks and 6 days' gestation. Women at risk for preterm delivery at 34 weeks to 36 weeks and 6 days should not receive Betamethasone.

• If cervical ripening is required, outpatient regimens should be prioritised.

• One support person, appropriately masked, should be permitted at the hospital.

• Neuraxial anaesthesia is an optimal approach to labour anaesthesia. Nitrous oxide should not be used because it might cause aerosolisation of respiratory secretions.

• Labour management and timing of delivery need not be altered during the pandemic. However, pregnant women with moderate or severe COVID-19 that is not improving may experience modest respiratory improvement if they are delivered preterm.

• Healthcare workers who are pregnant should stop face-to-face contact with patients after 36 weeks' gestation.