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Guidelines of Pregnancy during the New Coronavirus Pandemic (Covid-19)

Prepared by:

Dr. Fawaz Amin Saad

Senior consultant obstetrics and gynecology

Perhaps the anxiety pregnant women feel today - in light of the rapid spread of the Coronavirus (Covid-19) around the world - is greater than what everyone feels, so what can they do to ensure their safety and that of their fetuses?


Pregnancy in the time of Corona .. Is it necessary to postpone this step?

 Although the seriousness of the Coronavirus on a pregnant woman and newborn has not yet been proven, several factors have prompted health experts to warn women against pregnancy amid this crisis:

  • The first factor stems from the low level of health care in general around the world, because hospitals are busy dealing with emerging Coronavirus infections, which are rising with a frightening acceleration day after day. Hospitals that were not prepared to deal with a pandemic of this type will not be naturally prepared to deal with upcoming pregnancies amid the crisis.
  • The second reason is the lack of sufficient information about the effect of the Coronavirus on the fetus and the impact of infection on the newborn.

 This lack of information prompted experts to advise married couples to try to postpone pregnancy after this health crisis. But the exaggerated anxiety is also not true, according to obstetricians, especially since China had sent to the pregnant mothers some good news during the outbreak of the Coronavirus there, where Chinese Wuhan hospitals confirmed that 9 Children born to mothers infected with Coronavirus, were not infected with the virus after birth. This spread a glimmer of hope on the subject, but it is not enough to decide.

 According to experts, the importance of postponing pregnancy at the present time is due to the low level of health care, and not because of the danger of the virus to the mother and fetus.


Are pregnant women more susceptible to infection with Coronavirus?  Why are pregnant women in the group of the unvaccinated?

There is no scientific evidence on this subject, but pregnant women, as a result of changes that occur during pregnancy, are more likely to develop respiratory infections of viral origin, including the emerging Coronavirus.

The only caution is what motivated officials to place pregnant women in the unvaccinated category, as we know that some viral infections develop worse in pregnant women.

Pregnant women may also be more susceptible to severe symptoms of the Coronavirus, compared to others, according to tests performed on different coronaviruses such as MRAS, SARS, and regular influenza.

Therefore, pregnant women should try to avoid coronavirus by constantly washing hands, keeping away from patients, and following the criteria set by the competent authorities while maintaining regular contact with her doctor.


What is the effect of the Covid-19 virus on a pregnant woman?

 In general, it appears that the health of a pregnant woman differs from that of healthy adults when infected with Covid-19, and it is expected that most pregnant women will suffer from mild symptoms similar to influenza.

Severe symptoms, as well as pneumonia, are more common in older people, immunomodulators, and people suffering from chronic diseases, and there is no evidence so far that infection of a pregnant woman with Coronavirus poses a greater risk.

If you feel symptoms of Covid-19, you should request information through the communication services, and if symptoms become severe or recovery takes more time, this may be a sign of the development of a serious chest infection that needs special attention.


When diagnosed with the Covid-19 virus, what is the effect of this virus on my fetus?

 Coronavirus is a modern virus, and there is no evidence that it is transmitted to the fetus from the mother, which is medically called vertical transmission (mother-to-child transmission), but there are some recent reports that say the vertical transmission is possible, and it has not been proven that coronavirus causes miscarriage. In addition to that, the majority of cases in which a person was infected with the Coronavirus, the infection occurred after birth and it was not transmitted to him through the placenta from the mother, and all the newborns were in a good health condition. Coronavirus was associated with premature birth, but it was not known if these deliveries were brought about by doctors to preserve the mother's health.


What should I do to reduce the risk of infection with the Covid-19 virus?

One of the most important things is to follow the International Guidelines for Prevention of Infection with Covid-19. Pregnant women and the rest of the family should do the following:

  1. Wash your hands with soap and water regularly and repeatedly for at least 20 seconds, especially when returning home, going to work, or after visiting a public place.
  2. Use alcohol sterilizers when soap and water are not available.
  3. Cover your mouth and nose with a cloth, handkerchief, or hand elbow when you cough or sneeze. Members of your family should do this as well. Dispose of the handkerchief after that, and then wash your hands with soap and water.
  4. Avoid contact with anyone who has symptoms of Covid-19 infection, which includes high fever and / or modern and persistent coughing.
  5. Avoid touching eyes, nose, and mouth.
  6. Clean the various surfaces before you touch them, including your mobile phone, because Coronavirus can stay on them for several hours and sometimes days.
  7. Use a clean cloth to open the doors, then wash your hands or rub them with an alcohol sterilizer.
  8. Keep a safe distance between you and other people (at least one meter) and avoid handshaking and kissing when greeting others.
  9. Stay at home and exercise social distance with the rest of the family, and avoid going to public places unless absolutely necessary, and do not go out during peak times.
  10. Avoid using public transport, if it is not necessary, as much as possible.
  11. Try to complete the work from home if possible.
  12. Avoid small and large gatherings in public places, note that bars, restaurants, recreation centers, and similar places have been closed because sepsis easily spreads in enclosed spaces where people meet.
  13. Avoid meeting with friends and family, and try to communicate via technology such as phone, internet, and social media.
  14. Use phone or internet services to contact your doctor or obtain other services.


What to do if you suspect that you have Covid-19 disease or that you have been infected by an infected person?

If you are pregnant and have any of the following:

High fever and/or persistent recent cough and runny nose, you must stay at home for seven days. Do not go to a doctor, pharmacy, or hospital.

  • You do not need to contact the specialized centers to inform them about your stay at home.
  • You do not need a Covid-19 test.
  • Currently, Covid-19 test is only performed for people with severe symptoms requiring hospital admission.
  • If you have concerns about your health or the health of your fetus during the period of self-isolation, contact your doctor, he will provide you with more advice, including your need to see a hospital.
  • You should use Covid-19 online communication service or contact Qatar Ministry of Public Health on the hotline number 16000 in the following cases:
  • Your inability to control symptoms at home.
  • The situation is getting worse.
  • Your symptoms do not improve after seven days.


How can I be tested for Covid-19?

 The method for diagnosing Covid-19 is changing rapidly now, and a screening test is only done for people who have severe symptoms and need admission to the hospital. In case you request a screening test, the test will be made regularly as being made to any ordinary person even to a pregnant woman.

Currently, the test includes swabs from your mouth and nose, and you may also be required to cough to release expectoration.


What to do if the test is positive?

In the case of a positive Covid-19 test, you should contact your physician or antenatal care team to inform them about the diagnosis, in the event that you do not have any symptoms nor very severe symptoms, it is preferable that you recover at home.

 If the symptoms are severe, it is best to go to the hospital.


What should I do if I am asked to perform a self-isolation?

 Pregnant women who have been advised to perform self-isolation should stay home and avoid contact with others for seven days, and if you live with other people, they are supposed to stay home for at least 14 days to avoid spreading infections to others.


Current recommendations for self-isolation are:

  •  Don`t go to school, work, or public places.
  • Don`t use using public transportation.
  • Stay home and don`t receive any visitors
  • Ventilate the rooms where the isolated people are located by opening the windows.
  • Separating (the quarantined people) themselves from other family members as much as possible, using their own towels and cooking and eating tools, eating at different times from others.
  • rely on friends, family and delivery services for any help, and asking them to keep their things out.


Can I attend prenatal monitoring appointments if I am in self-isolation?

 You should contact a doctor or pregnant women follow-up clinic to inform them that you are currently in self-isolation because of an infection or possible infection with Covid-19 virus, and seek advice on routine follow-up visits.

 It is possible that the dates of the routine visit will be postponed until the end of the isolation if your doctor advises you that the appointment cannot be postponed, the necessary arrangements will be made to conduct your examination, for example, you may be asked to attend at different times or clinics to pro others.


What do I do if I feel unwell or worried about my child during the isolation period?

  • Pregnant women in self-isolation are not advised to come to the maternity units, or the ambulance and emergency department unless there is a need for an emergency medical care related or not related to pregnancy.
  • If you have concerns about your or your fetus' safety during the period of self-isolation, contact the medical team, they will give you more advice including if you need to go to the hospital.
  • In the event that you are advised to go to the hospital, pregnant women prefer to move by private means of transportation or by means of the hospital, with the hospital’s reception department informed when arriving at the building’s door before entering the hospital.


How shall you complete healthcare after recovering from the Covid-19 virus?

  • If you have confirmed infection with the Covid-19 virus, as a precaution, an ultrasound scan will be performed at least two weeks after recovery, to check on the health of the fetus.
  • In the event that a Covid-19 virus is cured and negative test results appear before reaching the labor period, the place and method of birth won`t be affected due to your previous condition.
  • The number of visitors may be determined in order to improve the recommended social distance, but your partner will be able to stay with you provide that he is not sick.


Is it better for a pregnant woman to remain in self-isolation at birth, in case of suspected or confirmed infection with Covid-19 virus?

During labor, it is preferable to be in obstetric centers for the electronic continuous monitoring of the fetus, and of the mother's oxygen levels every hour. Thus, home delivery or delivery by a midwife is not recommended, as it is preferable to have a specialist doctor to monitor the state of the fetus.


What is the best delivery way when there is a suspected or confirmed infection with coronavirus?

  • Up to date, there is no suggestion for the best method, as the choice is made according to the obstetric case.
  • If the woman's respiratory condition suggests that pregnancy should be terminated immediately, a cesarean section is recommended.
  • Water pool delivery is not recommended as the coronavirus is can be found within the stool, and therefore the virus can be crossed into the newborn, in addition to the difficulty of ensuring adequate protection for the newborn.
  • There is no evidence that anesthetic or spider anesthesia can not be used.


What happens if labor begins during the period of self-isolation?

  • You should contact the obstetric center for advice and inform them of the possible infection with the Coronavirus.
  • If there are mild symptoms, it is advised to stay home in the early stage of labor.
  • Follow the instructions of the medical team to ensure the safety of the mother and the fetus while discussing the best way for delivery.


If the pregnant woman is asked to attend at Labor and Delivery Division, the following instructions should be followed:

  • Using a private means of transportation or call service centers for assistance.
  • Placing the lady in a private isolation room, and the medical team shall use personal protection.
  • The maternity partner can accompany the woman during labor while keeping the visitors as few as possible.


Can a pregnant woman go to work and what if she works with the public?

  • It is understood that a pregnant woman is worried while working in this field and that all pregnant women are in the non-immunized group.
  • It is preferable for the pregnant woman to work from her home if possible, in the event that it is difficult, communication should  (must) be reduced as much as possible.
  • Occupational health advice for pregnant women who cannot work from their homes includes the following:
    • If the woman is in the first or second trimester of pregnancy (less than 28 weeks pregnant) and without medical problems, she can work with maintaining sufficient safety distance, and if she works within the field of health care, she must wear personal protection tools.
    • If you are in the third trimester of pregnancy (more than 28 weeks pregnant) and have medical problems such as heart and lung diseases, it is preferable to work from home if possible, while avoiding contact with anyone who has symptoms of Covid-19.


Can Coronavirus transmit from mother to child?

Up to date, there is insufficient evidence of transmission of the coronavirus, a small number of children infected with coronaviruses have been isolated quarantined after a short period of birth, so there may be a possibility of the presence of the virus inside the uterus, but it is not yet certain.


Shall Covid-19 test be made to the child after birth?

 In case the mother has a confirmed or suspected infection with the Coronavirus, the pediatricians must make a test to the child.


Are children more susceptible to infection with the Coronavirus?

  • No, there is no scientific evidence that children are more susceptible to infection with the emerging coronavirus compared to others, and that most of the cases recorded in China, as mentioned, were among adults.
  • Children and infants have been infected with the new virus, but information obtained from various coronaviruses indicates that children are less likely to be infected with the virus.
  • Children should take preventive steps, the most important of which is washing hands with soap and water or alcohol-free hand sanitizer, avoiding connection with the infected and taking the necessary flu vaccines.


Do infected children have the same symptoms?

Children who were infected with Coronavirus in China had symptoms similar to the common cold, such as high fever, runny nose, and cough. One case of an infected child suffered from vomiting and diarrhea.


Are the complications of the disease in children greater compared to others?

Since the number of children infected with the new coronavirus was small, the information available is not much, but it indicates that the complications may be severe sometimes, but it is not fatal.

But some children may be more at risk of complications if they have health problems and various other diseases.


Is there a treatment for children with Coronavirus?

Up to date, there is no treatment for infection with the emerging Coronavirus, which means that prevention is much more important than treatment. Therefore, children should be urged to follow protection methods all the time, the most important of which is washing hands with soap and water for at least 20 seconds.


Can Coronavirus affect the child later in his life if his mother was infected during pregnancy?

At the moment there is no information about coronavirus in the long run.


Does breastfeeding for an infected mother transmit the disease to the child?

Coronavirus is transmitted from the infected person to a healthy person through direct communication through respiratory droplets caused by coughing or sneezing.

The limited information available indicates that there is no evidence of the spread of the Coronavirus through breast milk, as studies of the SARS virus have indicated that the virus does not exist in breast milk, but that there may be antibodies to it in milk.


Is breastfeeding possible if there is a suspected or confirmed infection with Covid-19?

Yes, that can be done. There are no indications of coronavirus transmission through breastfeeding. The risk lies in direct contact with the child and the transmission of the virus through respiratory secretions.

Benefits and risks must be evaluated between the mother, family and the doctor. Guidelines may change as more information becomes available.

When breastfeeding, the following steps should be taken:

  • Wash hands with soap and water for 20 seconds before touching the baby or nipple.
  • Avoid coughing or sneezing while breastfeeding.
  • Wear a face mask while breastfeeding, if available.
  • Follow the cleaning instructions after each use.
  • In the event of milk suction, it is important to wash hands before using the machine and sterilize it when finished.


Prepared by:

Dr. Fawaz Amin Saad

Senior consultant obstetrics and gynecology

Al-Hayat Medical Center in Qatar

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