Guidelines for pregnant women with suspected SARS-CoV-2 infection
Authors: Guillaume Favre, Léo Pomar, Xiaolong Qi, Karin Nielsen-Saines, Didier Musso, David Baud
Journal: The Lancet Infectious Diseases (2020)

Coronaviruses responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) can cause severe adverse pregnancy outcomes, such as miscarriage, premature delivery, intrauterine growth restriction, and maternal death.1Alfaraj SH Al-Tawfiq JA Memish ZA Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: report of two cases & review of the literature.J Microbiol Immunol Infect. 2019; 52: 501-503Crossref PubMed Scopus (288) Google Scholar, 2Wong SF Chow KM Leung TN et al.Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome.Am J Obstet Gynecol. 2004; 191: 292-297Summary Full Text Full Text PDF PubMed Scopus (702) Google Scholar Vertical transmission of the virus responsible for 2019 novel coronavirus disease (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has not yet been detected, whereas perinatal transmission has been suspected in one case.3Chen H Guo Juanjuan Wang C et al.Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.Lancet. 2020; (published online Feb 12.)https://doi.org/10.1016/S0140-6736(20)30360-3Summary Full Text Full Text PDF Scopus (2639) Google Scholar Consequences of infection with SARS-CoV-2 for pregnancies are uncertain, with no evidence so far of severe outcomes for mothers and infants; however, the possibility should be considered.4Favre G Pomar L Musso D Baud D 2019-nCoV epidemic: what about pregnancies?.Lancet. 2020; 395: e40Summary Full Text Full Text PDF PubMed Scopus (154) Google Scholar The recent experience with Zika virus suggests that when a new pathogen emerges, the health-care community should be prepared for the worst-case scenario.5Musso D Ko AI Baud D Zika virus infection—after the pandemic.N Engl J Med. 2019; 381: 1444-1457Crossref PubMed Scopus (310) Google Scholar Therefore, recommendations for management of pregnant women at risk of SARS-CoV-2 infection are urgently needed. To this end, we propose a detailed management algorithm for health-care providers (appendix). In the algorithm, we suggest that any pregnant woman who has travelled in a country affected by SARS-CoV-2 within the previous 14 days or who has had close contact with a patient with confirmed SARS-CoV-2 infection should be tested with a SARS-CoV-2 nucleic acid amplification test,6WHOLaboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. Interim guidance. World Health Organization, Geneva2020Google Scholar even if asymptomatic. Pregnant women with laboratory-confirmed SARS-CoV-2 infection who are asymptomatic should be self-monitored at home for clinical features of COVID-19 for at least 14 days. These patients and those recovering from mild illness should be monitored with bimonthly fetal growth ultrasounds and Doppler assessments because of the potential risk for intrauterine growth restriction. Pregnant women with COVID-19 pneumonia should be managed by a multidisciplinary team at a tertiary care centre. When quick Sepsis-related Organ Failure Assessment criteria are met, the patient should be transferred to an intensive care unit. For pregnant women with confirmed infection, the choice of delivery timing should be individualised depending on the week of gestation and maternal, fetal, and delivery conditions. Whenever possible, vaginal delivery via induction of labour, with eventual instrumental delivery to avoid maternal exhaustion, should be favoured to avoid unnecessary surgical complications in an already sick patient. Septic shock, acute organ failure, or fetal distress should prompt emergency cesarean delivery (or termination if legal before fetal viability). Newborns of mothers positive for SARS-CoV-2 should be isolated for at least 14 days or until viral shedding clears, during which time direct breastfeeding is not recommended. These recommendations should be adapted to local health-care facilities, as well as in response to any further updates on SARS-CoV-2 and COVID-19. We declare no competing interests. Download .pdf (.24 MB) Help with pdf files Supplementary appendix A Spanish-translated clinical algorithm for management of suspected SARS-CoV-2 infection in pregnant womenWith interest, we read the guidelines by Guillaume Favre and colleagues1 on the management of pregnant women with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Full-Text PDF COVID-19 in pregnant womenWith interest, we read the recommendation on the management of pregnant women with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by Guillaume Favre and colleagues.1 Some of the recommendations made in the flowsheet of their Correspondence have long-term consequences (eg, termination of pregnancy, no breastfeeding) of an unforeseeable extent, are harmful when applied to the general population (eg, early cord clamping in extremely preterm infants, no breastfeeding, separation of the mother from the newborn), are not proven to reduce the risk of transmission in other viral illnesses (eg, early cleaning of the newborn), and are contradictory to the current recommendations by the US Centers for Disease Control and Prevention (CDC) for the management of coronavirus disease 2019 (COVID-19; eg, testing of asymptomatic people, no breastfeeding). Full-Text PDF COVID-19 in pregnant women – Authors' replyWe are grateful for the concerns of Manuel Schmidt and colleagues about our previous guidelines1 for pregnant women with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. At the time we developed the algorithm (February, 2020), there were no data regarding potential vertical transmission from infected mothers and outcomes in newborns. To date, there has been no evidence of vertical transmission of coronavirus disease 2019 (COVID-19) based on two small clinical series. Full-Text PDF