Guidelines for health care providers regarding management of pregnant women during pandemic

The ICMR has released guidelines for healthcare facilities providing obstetric care for pregnant patients with confirmed COVID-19 case or pregnant Persons Under Investigation (PUI) in obstetric healthcare settings including obstetrical triage, labour and delivery, recovery and inpatient postpartum settings. The guidelines are based on recommendations from international agencies like CDC, ACOG, RCOG, FOGSI and Lancet publications. 

  • Obstetrician-gynaecologists and other health care practitioners should contact their local and/or state health department for guidance on testing persons under investigation and should follow the national protocol.  
  • Health care practitioners should immediately notify infection control personnel at their health care facility and their local or state health department in the event of a PUI for COVID-19.  
  • A registry for all women admitted with confirmed COVID-19 infection in pregnancy should be maintained. Maternal and neonatal records including outcome should be completed in detail and preserved for analysis in future.  
  • Health care providers should create a plan to address the possibility of a decreased health care workforce, potential shortage of personal protective equipment, limited isolation rooms, and should maximize the use of telehealth across as many aspects of prenatal care as possible. 
  • Each facility should consider its appropriate space and staffing needs to prevent transmission of the virus that causes COVID-19.  
  • Pregnant women should be advised to increase their social distancing to reduce the risk of infection and practice hand hygiene.  
  • Health care practitioners should promptly notify infection control personnel at their facility of the anticipated arrival of a pregnant patient who has confirmed COVID-19 or is a PUI so that infection control measures can be kept in place.  
  • Intrapartum services should be provided in a way that is safe, with reference to minimum staffing requirements and the ability to provide emergency obstetric, anaesthetic and neonatal care where indicated.  
  • A single, asymptomatic birth partner should be permitted to stay with the woman, at a minimum, through pregnancy and birth. Visitors should be instructed to wear appropriate PPE, including gown, gloves, face mask, and eye protection.  
  • Women should be met at the maternity unit entrance by staff wearing appropriate PPE and be provided with a surgical face mask. The face mask should not be removed until the woman is isolated in a suitable room. 
  •  Staff providing care should take Personal Protective Equipment (PPE) precautions as per national guidance.

Do’s and Don’ts for Obstetric care providers in COVID-19 Pandemic  

  • If a woman meets the criteria for COVID-19 testing, she should be tested. Until test results are available, she should be treated as though she has confirmed COVID-19.  
  • Do not delay obstetric management in order to test for COVID-19.  
  • Elective procedures like induction of labour for indications that are not strictly necessary, routine growth scans not for a strict guidance-based indication and routine investigations should be reduced to a minimum at the discretion of the care provider.  
  • If ultrasound equipment is used, it should be decontaminated after use.

Breastfeeding and COVID-19

Current evidence suggests that breast milk is not likely to spread the virus to babies, according to the CDC. The family and healthcare providers should decide whether and how to start or continue breastfeeding. 

If one has COVID-19 and chooses to breastfeed

  • Wash hands before breastfeeding
  • Wear a mask while breastfeeding and whenever you are within 6 feet of your baby.

If one has COVID-19 and chooses to express breast milk

  • Use your own breast pump (one not shared with anyone else), if possible.
  • Wear a mask during expression.
  • Wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts, and before expressing breast milk.
  • Follow recommendations for proper pump cleaning after each use.  Clean all parts of the pump that come into contact with breast milk.
  • Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

COVID-19 is uncommon in newborns born to mothers who had COVID-19 during pregnancy. Some newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth. Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness.

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