Coronavirus: UK advice for pregnant women


Coronavirus: UK advice for pregnant women

The UK government has now classed expectant mothers as those among the "vulnerable" group of society at risk of Covid-19

Professor Chris Whitty, England's Chief Medical Officer, said that including pregnant women in this group was a "precautionary measure" as experts are "early in our understanding of this virus".

And his deputy, Professor Jonathan Van-Tam, said it's hoped that these new measures will reduce the infection rate and protect those at higher risk.

He told the BBC: "When it comes to this coronavirus, it is a new disease, it's been with humans around the world for just a few months.

"We are being very precautionary in terms of the advice we are giving to pregnant women to increase their social distancing.

"We know that a whole range of normal infections are more serious in pregnancy and the advice we're giving is extremely precautionary."

He added: "The early signal, and it is only an early signal, is that the highest risk is only going to be towards the end of the third trimester, so from the 34th week, that kind of position in the pregnancy.

"But we are being very precautionary and saying that because we don't know enough about this disease yet.

"We haven't got enough information on the disease in pregnant women, that the best thing to do is take a precautionary approach and advise social distancing and to identify that this is strongly advised for pregnant women as a whole group."

What's the risk to pregnant women?

According to the Royal College of Obstetricians and Gynaecologists (RCOG), the large majority of women will experience only mild or moderate symptoms.

These include a cough, fever and shortness of breath.

More severe symptoms, such as pneumonia, are widely described in older people and those with underlying conditions.

However, they say that these symptoms could occur in pregnant women, and have advised healthcare professionals that these should be identified and treated promptly.

So far, there has been just one reported case of a woman with Covid-19 who required mechanical ventilation at 30 weeks’ pregnant, following which she had an emergency caesarean section and made a good recovery, they noted.

There has also been no reported deaths in pregnant women who have contracted the new coronavirus.

Experts also say that there is currently no data to suggest that there is an increased risk of miscarriage or early pregnancy loss in relation to Covid-19.

They added that it's considered unlikely that there will be congenital effects of the virus on foetal development.

According to their advice, the professonial body said: "There is also no evidence that the virus can pass to your developing baby while you are pregnant (this is called vertical transmission).

"It is therefore considered unlikely that if you have the virus it will cause abnormalities in your baby.

"Some babies born to women with symptoms of coronavirus in China have been born prematurely.

"It is unclear whether coronavirus caused this or the doctors made the decision for the baby to be born early because the woman was unwell. As we learn about the risk of pre-term birth and coronavirus infection, we will update this information."

Can babies catch it?

As this is a new virus, there is limited evidence about managing coronavirus infection in those who have just given birth.

However, there are no reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.

And if you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.

When should pregnant women self-isolate?

Based on the current government advice, you may be asked to self-isolate if you have symptoms of coronavirus, such as a high temperature or a new, continuous cough, or you've been tested positive for the illness.

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 7 days.

The NHS guidance on self-isolation currently recommends people should:

  • Not go to school, work, NHS settings or public areas
  • Not use public transport
  • Stay at home and not allow visitors
  • Ventilate the rooms where they are by opening a window
  • Separate themselves from other members of their household as far as possible, using their own towels, crockery and utensils and eating at different times
  • Use friends, family or delivery services to run errands, but advise them to leave items outside.

You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates.

Pregnant women are advised not to attend maternity triage units or A&E unless in need of urgent pregnancy or medical care.

The RCOG said: "If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife, or out-of-hours, your maternity team.

"They will provide further advice, including whether you need to attend hospital.

"If attendance at the maternity unit or hospital is advised, pregnant women are requested to travel by private transport, or arrange hospital transport, and alert the maternity triage reception once on the premises, prior to entering the hospital."

How will self-isolating affect labour?

As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour, are being advised to attend an obstetric unit for birth.

This way the baby can be monitored using continuous electronic fetal monitoring, and the mum's oxygen levels can be monitored hourly.

As this can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife led unit, where only midwifes would be present.

The experts also say that there is no evidence to suggest that you cannot give birth vaginally - or that you'd be safer having a c-section.

Therefore your birth plan should be followed as closely as possible based on your wishes.

However, if your respiratory condition suggested that urgent delivery would be needed, a caesarean birth may be recommended.

The experts added: "There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block.

"However, the use of gas and air may increase aerosolisation and spread of the virus, so your maternity team will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you."

Should you attend antenatal appointments?

The RCOG says that you should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and request advice on attending routine antenatal appointments.

It is likely that routine antenatal appointments will be delayed until isolation ends.

If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen.

For example, you may be asked to attend at a different time, or in a different clinic, to protect other patients.

What happens after recovering from coronavirus?

If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged 14 days after your recovery, according to health officials.

This 14 day period may be reduced as more information on how infected people are in recovery becomes available, they added.

If you have recovered from coronavirus and tested negative for the virus before you go into labour, where and how you give birth will not be affected by your previous illness.

Can we have skin-to-skin contact after birth?

Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth - so you can still have skin-to-skin contact.

There are some reports from China which suggest women with confirmed coronavirus have been advised to separate from their baby for 14 days.

However, this may have potential negative effects on feeding and bonding and women should discuss the risks and benefits with their doctor.

Should I breastfeed?

Prof Van-Tam also said that women shouldn't stop breastfeeding if they show coronavirus symptoms.

He said: "The Royal College of Obstetricians and Gynaecologists has looked at this for us and concluded that there is no obvious risk associated with breastfeeding.

"As you know breastfeeding is incredibly important for the baby, it's incredibly important for mother and baby bonding.

"Our advice at the moment is that with respect that's an individual woman's choice as to whether she breastfeeds, but our advice is that this is the best thing to do."

The RCOG added that there is some evidence to suggest that they could be a group of asymptomatic individuals with very minor symptoms that are carrying the virus - however the incidence is unknown.

Last week, the professional body updated its guidance to say that as a precautionary measure, pregnant women with suspected or confirmed coronavirus are advised to attend an obstetric unit when they go into labour - but their birth plan should be followed as closely as possible.

Following the policy announcement made by the UK government last night, the RCOG said that along with the Royal College of Midwives and Royal College of Paediatrics and Child Health, it would be updating its guidance as soon as possible.

Article source: 17th March 2020