SlideShare a Scribd company logo
1 of 18
5/8/2020
ABOUBAKR ELNASHAR 1
COVID-19 &
Pregnancy
What obstetrician needs to
know?
 Sexual intercourse
 Infertility
 ART
 Pregnancy
Prof. Aboubakr Elnashar
Benha university Hospital, Egypt
ABOUBAKR ELNASHAR
 Vertical transmission
(transmission from mother to baby antenatally or intrapartum)
 China: no evidence
{amniotic fluid, cord blood, neonatal throat swabs,
placenta swabs, genital fluid, breast milk samples
from infected mothers: negative for the virus}.
 RCOG, 2020, 21 April: probability
 2 reports: {IgM for SARS-COV-2 in neonatal
serum at birth. Since IgM does not cross the
placenta,± represent a neonatal immune
response to in utero infection}.ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 2
Sexual transmission (UNICEF, 2020)
 NO
{not found in semen or vaginal fluid}
 But: SI involves close contact, kissing& touching,
these are the ways of transmitting this virus
 Avoid sex if you or your husband (New York City Health, 2020)
1. Confirmed Covid19
2. Suspected Covid 19
3. High risk for severe Covid-19
ABOUBAKR ELNASHAR
DIAGNOSIS
 Suspected cases (22.4.2020)
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 3
22.4.2020
ABOUBAKR ELNASHAR
 Single chest radiograph
 Very low fetal radiation dose (0.0005 to 0.01 mGy)
Abdominal shielding
 CT
 should be performed, if indicated
 fetal radiation dose is low
 Not associated with an increased risk of
 fetal anomalies or
 pregnancy loss.
 Pulmonary ultrasound
 quick diagnosis of pneumonia
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 4
ABOUBAKR ELNASHAR
EFFECTS ON PREGNANCY
1. Maternal
 Not more likely to contract COVID19
1. More severe infection
 Pneumonia
 Marked hypoxia
 In late pregnancy, compared with early
pregnancy.
 The absolute risks: Small
2. Increased risk of DVT
{Reduced mobility from self-isolation at home, or hospital
admission}
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 5
2. Effect on the fetus
 No increased risk of
 Miscarriage or early pregnancy loss
 Teratogenicty .
1. Fetal compromise
2. Prelabour PROM
3. Hyperthermia during organogenesis: congenital
anomalies, NTD, or miscarriage.(Theoretical)
ABOUBAKR ELNASHAR
 Yan et al, 2020. 24 April
116 pregnant women withCOVID-19 in China
 The most common symptoms
 Fever: 50.9%
 Cough: 28.4%
 No sym: 23.3%.
 Abnormal radiologic findings in 96.3% of cases.
 Severe pneumonia: 6.9%. no maternal deaths.
 PTL: 23.2%
 Spontaneous PROM: 6.1%
 CS: 85.9%
 NICU: 47% Neonatal death: 1%.ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 6
MANAGEMENT
 MULTIDISCIPLINARY TEAM
1. Chest specialist
2. Intensivist
3. OBSTETRICIAN
4. Anesthesiologist
5. Neonatologist
6. Microbiologist
7. infection control specialist
A. MEDICAL
B. OBSTETRICAL
ABOUBAKR ELNASHAR
A. MEDICAL
22.4.2020
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 7
ABOUBAKR ELNASHAR
OBSTETRICAL
I. ANTENATAL CARE (RCOG, 2020)
 Appointments
 Limited with remote consultation by telephone
 Women who have had symptoms
 deferred until 7 days after the start of
symptoms, unless symptoms (aside from
persistent cough) persevere.
 Suspected or confirmed COVID-19
 delayed until after the recommended period of
isolation 14 days
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 8
 Antenatal Clinic
 Separate for suspected or confirmed COVID-19.
 Dedicated team
 appropriate PPE.
 Dedicated equipment
 Remove non-essential items
 US machine
 decontaminated after each use.
 Transducers are cleaned and disinfected
 Protective covers for probes and cables.
ABOUBAKR ELNASHAR
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 9
 Procedures
 US & other investigations (urine &blood tests in
same visit
 US for F growth& anatomy.
 Electronic FHR monitoring
 Doppler assessment
 Amniocentesis
 Not recommended in active infection.
ABOUBAKR ELNASHAR
2. Use of medications to manage pregnancy
 Antenatal betamethasone
 CDC: avoiding glucocorticoids in COVID-19-
positive { increased risk for mortality}
 ACOG: between 24+0 &33+6 w in patients at
high risk of PTL within 7 days
 Not 34+0 to 36+6 w
 {benefits to the neonate are less clear}
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 10
 Low-dose aspirin
 For prevention of PET.
 Suspected or confirmed COVID-19 for whom LDA
would be indicated, the decision to continue should
be individualized & is usually possible.
 Continuing is not worthwhile in
 Severely or critically ill patients or
 Near term
ABOUBAKR ELNASHAR
 NSAIDs (ibuprofen)
 Early in the course of infection: severe disease
 No clinical or population-based data that directly address
the risk of NSAIDs.
 WHO do not recommend avoiding NSAIDs in COVID-19 patients
when clinically indicated
 Acetaminophen
 In the first trimester
 Fever
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 11
 Tocolysis
 Nifedipine
 Not:
 Indomethacin, which is subject to the concerns
discussed above
 Beta sympathomimetics, which can further
increase the maternal heart rate.
ABOUBAKR ELNASHAR
3. Delivery timing
 Depend upon:
1. Mother's clinical status
2. Gestational age
3. Fetal well-being.
 Improvement mother's condition: improve fetal
status: pregnancies allowed to continue to term.
 If woman is critically ill, deterioration : IUF demise
or loss of both mother& infant: early delivery
 Infectious: Elective CS ± delayed, if possible
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 12
 Mg sulfate —
 Indication
 maternal seizure prophylaxis
 neonatal neuroprotection
 Women with respiratory compromise
{Mg sulfate ±depress respirations}.
 Consultation with maternal-fetal medicine&
pulmonary/critical care specialists.
ABOUBAKR ELNASHAR
II.INTRAPARTUM
1. Evaluation of all patients on admission
2. PPE on labor
 All clinicians
 All asymptomatic patients
3. Mode of delivery
 Based on obstetric indications, as there is no clear
benefit of delivery via CS
 Seriously ill patients & need urgent delivery
should be by category 1 CS.
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 13
4. Analgesia & anesthesia
 Regional Anasthesia by epidural or spinal
 Recommended .
 General anesthesia (intubation & extubation)
 Considered an aerosolizing procedure
 The scrub team should
 Scrub & wear PPE (N-95) before the general
anesthesia is commenced.
ABOUBAKR ELNASHAR
 Nitrous oxide
 Not recommended
 {insufficient data about cleaning, filtering, potential
aerosolization of nitrous oxide systems}.
 Intravenous, patient-controlled analgesia
 limiting use
 {risk of respiratory depression}.
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 14
5. Labor management
 Person-to person contact & time in the labor unit &
hospital should be limited
 Maternal observations:
 T, RR, oxygen saturation to be kept above 94%.
 Fluid chart to avoid fluid overload.
 Continuous CTG
 Shortening of the second stage
ABOUBAKR ELNASHAR
 Rupture of membranes&internal FHR monitoring
 ±performed, but data are limited
 {COVID19 has not been detected in vaginal secretions or
amniotic fluid}
 Pushing
 often causes loss of feces, which can contain the
virus & spread the infection
 Not delaying pushing in 2nd stage.
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 15
 Delayed cord-clamping:
 Unlikely to increase the risk of transmitting virus
from infected mother to the fetus
(ACOG, RCOG, EMH, April 2020)
 Oxygen therapy for fetal resuscitation
 Should be abandoned
{no proven fetal benefit
nasal cannula& face mask used are in contact with
the maternal respiratory tract& secretions: increases
contamination/exposure between pt. &provider}.
ABOUBAKR ELNASHAR
 Neonate should be
 Cleaned& dried immediately
 Leaving vernix caseosa in place for 24 h since it
contains antimicrobial peptides.
 Isolated for 14 days
 Closely monitored for clinical manifestations of
infection.
 The mother & newborn
 May need to be isolated separately until both are
cleared
ABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 16
III. Post partum care
1. Placental disposal
 The placenta should be treated as biohazardous
waste
ABOUBAKR ELNASHAR
3. Breast feeding: (EMH, April 2020)
 Not recommended.
 If the mother is severely or critically ill
 express breast milk with a pump to maintain milk production (the
pump should be cleaned after each use).
 Can be considered
 If the mother is asymptomatic or mildly affected,
{virus is transmitted by respiratory droplets rather than breast milk}
 Mothers should:
 wash their hands
 wear a mask
 avoid coughing or sneezingABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 17
5. Postpartum fever
 COVID-19 should be part of the dd particularly
 respiratory symptoms &
 reduced oxygenation.
 Such patients should be
 tested for the virus
 evaluation for common causes of intrapartum
&postpartum infection:
 Chorioamnionitis
 Endometritis
ABOUBAKR ELNASHAR
6. Postpartum office visits
 Should be limited to reduce the risk of inadvertent exposure.
 Early postpartum assessments: wound &blood
pressure checks, with telephone.
 After 4-8 w: psychological assessment
 Screen for postpartum depression: self-report,
10-item Edinburgh Postnatal Depression Scale,
which can be completed in 5 minutes
 Severe anxiety and support offered.
 After 12W: A comprehensive assessment
especially in patients with comorbiditiesABOUBAKR ELNASHAR
5/8/2020
ABOUBAKR ELNASHAR 18
TAKE HOME MESSAGE
1. No evidence of miscarriage, F. congenial fetal
malformation.
2. It may cause PTL, PPROM, F. compromise
3. ANC should be delayed till the symptoms improve
4. Separate room, dedicated team, appropriate PPE.
dedicated equipment
5. Delivery timing depend upon: Mother's clinical status
G. age & F. well-being.
6. Mode of delivery based on obstetric indications
7. Regional anasthesia by epidural or spinal
8. The placenta is treated as biohazardous waste
9. Breast feeding not recommended if the mother is
severely or critically ill
ABOUBAKR ELNASHAR
 For CONID 19 AND Pregnancy: The following
statements are correct except
A. Increased risk of DVT during pregnancy
B. It is not sexually transmitted
C. Corticosteroid is indicated between 24+0 &33+6 w
in patients at high risk of PTL within 7 days
D. Oxygen therapy for fetal resuscitation is
recommended
E. Delayed cord-clamping is unlikely to increase risk
of transmitting virus from infected mother to fetus
ABOUBAKR ELNASHAR

More Related Content

What's hot

Prediction of pregnancy outcome and multiple gestation by measurement of seru...
Prediction of pregnancy outcome and multiple gestation by measurement of seru...Prediction of pregnancy outcome and multiple gestation by measurement of seru...
Prediction of pregnancy outcome and multiple gestation by measurement of seru...Aboubakr Elnashar
 
The 10 recommendations of society of maternal fetal medicine 2016
The 10 recommendations of society of maternal fetal medicine 2016The 10 recommendations of society of maternal fetal medicine 2016
The 10 recommendations of society of maternal fetal medicine 2016Aboubakr Elnashar
 
PREGNANCY OUTCOMES AFTER ART
PREGNANCY OUTCOMES AFTER ARTPREGNANCY OUTCOMES AFTER ART
PREGNANCY OUTCOMES AFTER ARTAboubakr Elnashar
 
Some important questions in obstetrics and gynecology
Some important questions in obstetrics and gynecologySome important questions in obstetrics and gynecology
Some important questions in obstetrics and gynecologyAboubakr Elnashar
 
Recurrent miscarriage RCOG, 2011 Up to date, 2013
Recurrent miscarriage RCOG, 2011 Up to date, 2013Recurrent miscarriage RCOG, 2011 Up to date, 2013
Recurrent miscarriage RCOG, 2011 Up to date, 2013Aboubakr Elnashar
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationAboubakr Elnashar
 
PREVENTION OF MALE INFERTILITY
PREVENTION OF MALE INFERTILITYPREVENTION OF MALE INFERTILITY
PREVENTION OF MALE INFERTILITYAboubakr Elnashar
 
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015Aboubakr Elnashar
 
POOR RESPONDERS: Minimal Vs. Maximal stimulation
POOR RESPONDERS: Minimal Vs. Maximal stimulationPOOR RESPONDERS: Minimal Vs. Maximal stimulation
POOR RESPONDERS: Minimal Vs. Maximal stimulationAboubakr Elnashar
 
Hysteroscopy Overview of systematic reviews
Hysteroscopy   Overview of systematic reviews Hysteroscopy   Overview of systematic reviews
Hysteroscopy Overview of systematic reviews Aboubakr Elnashar
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Aboubakr Elnashar
 
The 10 recommendations of society for maternal fetal medicine" AN Testing
The 10 recommendations of society for maternal fetal medicine" AN TestingThe 10 recommendations of society for maternal fetal medicine" AN Testing
The 10 recommendations of society for maternal fetal medicine" AN TestingAboubakr Elnashar
 
invasive procedures for prenatal diagnosis ISUOG Guidelines
invasive procedures for prenatal diagnosis ISUOG Guidelines invasive procedures for prenatal diagnosis ISUOG Guidelines
invasive procedures for prenatal diagnosis ISUOG Guidelines Aboubakr Elnashar
 
Aboubakr elnashar lectures on ART
Aboubakr elnashar lectures on ARTAboubakr elnashar lectures on ART
Aboubakr elnashar lectures on ARTAboubakr Elnashar
 

What's hot (20)

Prediction of pregnancy outcome and multiple gestation by measurement of seru...
Prediction of pregnancy outcome and multiple gestation by measurement of seru...Prediction of pregnancy outcome and multiple gestation by measurement of seru...
Prediction of pregnancy outcome and multiple gestation by measurement of seru...
 
The 10 recommendations of society of maternal fetal medicine 2016
The 10 recommendations of society of maternal fetal medicine 2016The 10 recommendations of society of maternal fetal medicine 2016
The 10 recommendations of society of maternal fetal medicine 2016
 
PREGNANCY OUTCOMES AFTER ART
PREGNANCY OUTCOMES AFTER ARTPREGNANCY OUTCOMES AFTER ART
PREGNANCY OUTCOMES AFTER ART
 
Some important questions in obstetrics and gynecology
Some important questions in obstetrics and gynecologySome important questions in obstetrics and gynecology
Some important questions in obstetrics and gynecology
 
Recurrent miscarriage RCOG, 2011 Up to date, 2013
Recurrent miscarriage RCOG, 2011 Up to date, 2013Recurrent miscarriage RCOG, 2011 Up to date, 2013
Recurrent miscarriage RCOG, 2011 Up to date, 2013
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulation
 
Reurrent Miscarriage
Reurrent MiscarriageReurrent Miscarriage
Reurrent Miscarriage
 
IUCD: Uterine perforation
IUCD: Uterine perforationIUCD: Uterine perforation
IUCD: Uterine perforation
 
PREVENTION OF MALE INFERTILITY
PREVENTION OF MALE INFERTILITYPREVENTION OF MALE INFERTILITY
PREVENTION OF MALE INFERTILITY
 
Unexplained infertility
Unexplained infertilityUnexplained infertility
Unexplained infertility
 
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015
PREMATURE OVARIAN INSUFFICIENCY ESHRE Guidelines, 2015
 
Antiphospholipid syndrome
Antiphospholipid syndromeAntiphospholipid syndrome
Antiphospholipid syndrome
 
POOR RESPONDERS: Minimal Vs. Maximal stimulation
POOR RESPONDERS: Minimal Vs. Maximal stimulationPOOR RESPONDERS: Minimal Vs. Maximal stimulation
POOR RESPONDERS: Minimal Vs. Maximal stimulation
 
Hysteroscopy Overview of systematic reviews
Hysteroscopy   Overview of systematic reviews Hysteroscopy   Overview of systematic reviews
Hysteroscopy Overview of systematic reviews
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022
 
The 10 recommendations of society for maternal fetal medicine" AN Testing
The 10 recommendations of society for maternal fetal medicine" AN TestingThe 10 recommendations of society for maternal fetal medicine" AN Testing
The 10 recommendations of society for maternal fetal medicine" AN Testing
 
invasive procedures for prenatal diagnosis ISUOG Guidelines
invasive procedures for prenatal diagnosis ISUOG Guidelines invasive procedures for prenatal diagnosis ISUOG Guidelines
invasive procedures for prenatal diagnosis ISUOG Guidelines
 
Aboubakr elnashar lectures on ART
Aboubakr elnashar lectures on ARTAboubakr elnashar lectures on ART
Aboubakr elnashar lectures on ART
 
Infertility management 2019
Infertility management 2019Infertility management 2019
Infertility management 2019
 
RECURRENT PREGNANCY LOSS
RECURRENT PREGNANCY LOSSRECURRENT PREGNANCY LOSS
RECURRENT PREGNANCY LOSS
 

Similar to Covid19 & pregnancy

Corona Virus Infection in Pregnancy by: Prof. Haleema A. Hashmi
Corona Virus Infection in Pregnancy by: Prof. Haleema A. HashmiCorona Virus Infection in Pregnancy by: Prof. Haleema A. Hashmi
Corona Virus Infection in Pregnancy by: Prof. Haleema A. HashmiUsman Hingoro
 
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19MrityunjoyBaroi1
 
Nonimmune hydrops fetalis . Dr B M Rakshit
Nonimmune  hydrops  fetalis .  Dr B M RakshitNonimmune  hydrops  fetalis .  Dr B M Rakshit
Nonimmune hydrops fetalis . Dr B M RakshitBibek Rakshit
 
Assessment of Mother, Fetus and Newborn with.pptx
Assessment of Mother, Fetus and Newborn with.pptxAssessment of Mother, Fetus and Newborn with.pptx
Assessment of Mother, Fetus and Newborn with.pptxdrshonarkar
 
Management of mild covid infection in pregnancy
Management of mild covid infection in pregnancy Management of mild covid infection in pregnancy
Management of mild covid infection in pregnancy Niranjan Chavan
 
ART PREGNANCY COMPLICATIONS Prof. Aboubakr Elnashar
ART PREGNANCY COMPLICATIONS           Prof. Aboubakr ElnasharART PREGNANCY COMPLICATIONS           Prof. Aboubakr Elnashar
ART PREGNANCY COMPLICATIONS Prof. Aboubakr ElnasharAboubakr Elnashar
 
Clinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centreClinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centreiosrjce
 
Obstetrical emergencies 2.12.2020
Obstetrical emergencies 2.12.2020Obstetrical emergencies 2.12.2020
Obstetrical emergencies 2.12.2020Shazia Iqbal
 

Similar to Covid19 & pregnancy (20)

Covid & reproduction
Covid & reproductionCovid & reproduction
Covid & reproduction
 
HIV in pregnancy
HIV in pregnancyHIV in pregnancy
HIV in pregnancy
 
Corona Virus Infection in Pregnancy by: Prof. Haleema A. Hashmi
Corona Virus Infection in Pregnancy by: Prof. Haleema A. HashmiCorona Virus Infection in Pregnancy by: Prof. Haleema A. Hashmi
Corona Virus Infection in Pregnancy by: Prof. Haleema A. Hashmi
 
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19
CARE OF PREGNANT WOMEN WITH AYURVEDA IN COVID19
 
Covid19 and pregnancy
Covid19 and pregnancyCovid19 and pregnancy
Covid19 and pregnancy
 
Covid19 and pregnancy
Covid19 and pregnancyCovid19 and pregnancy
Covid19 and pregnancy
 
Nonimmune hydrops fetalis . Dr B M Rakshit
Nonimmune  hydrops  fetalis .  Dr B M RakshitNonimmune  hydrops  fetalis .  Dr B M Rakshit
Nonimmune hydrops fetalis . Dr B M Rakshit
 
Ivf in covid 19
Ivf in covid 19Ivf in covid 19
Ivf in covid 19
 
ART PREGNANCY COMPLICATIONS
ART PREGNANCY COMPLICATIONSART PREGNANCY COMPLICATIONS
ART PREGNANCY COMPLICATIONS
 
Assessment of Mother, Fetus and Newborn with.pptx
Assessment of Mother, Fetus and Newborn with.pptxAssessment of Mother, Fetus and Newborn with.pptx
Assessment of Mother, Fetus and Newborn with.pptx
 
Management of mild covid infection in pregnancy
Management of mild covid infection in pregnancy Management of mild covid infection in pregnancy
Management of mild covid infection in pregnancy
 
Corona and pregnancy
Corona and pregnancyCorona and pregnancy
Corona and pregnancy
 
Prom
PromProm
Prom
 
ART PREGNANCY COMPLICATIONS Prof. Aboubakr Elnashar
ART PREGNANCY COMPLICATIONS           Prof. Aboubakr ElnasharART PREGNANCY COMPLICATIONS           Prof. Aboubakr Elnashar
ART PREGNANCY COMPLICATIONS Prof. Aboubakr Elnashar
 
Chickenpox in pregnancy
Chickenpox in pregnancyChickenpox in pregnancy
Chickenpox in pregnancy
 
Clinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centreClinical study of Eclampsia and outcome in a tertiary care centre
Clinical study of Eclampsia and outcome in a tertiary care centre
 
hepatitis B.pdf
hepatitis B.pdfhepatitis B.pdf
hepatitis B.pdf
 
Obstetrical emergencies 2.12.2020
Obstetrical emergencies 2.12.2020Obstetrical emergencies 2.12.2020
Obstetrical emergencies 2.12.2020
 
Vaccination and pregnancy
Vaccination and pregnancyVaccination and pregnancy
Vaccination and pregnancy
 
hepatitis c2022.pdf
hepatitis c2022.pdfhepatitis c2022.pdf
hepatitis c2022.pdf
 

More from Aboubakr Elnashar

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertilityAboubakr Elnashar
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversyAboubakr Elnashar
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gynAboubakr Elnashar
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineAboubakr Elnashar
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA Aboubakr Elnashar
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021 Aboubakr Elnashar
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown locationAboubakr Elnashar
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021Aboubakr Elnashar
 
PREECLAMPSIA‐ECLAMPSIA SPECTRUM
PREECLAMPSIA‐ECLAMPSIA SPECTRUMPREECLAMPSIA‐ECLAMPSIA SPECTRUM
PREECLAMPSIA‐ECLAMPSIA SPECTRUMAboubakr Elnashar
 
Ovarian cysts and infertility
Ovarian cysts and infertilityOvarian cysts and infertility
Ovarian cysts and infertilityAboubakr Elnashar
 

More from Aboubakr Elnashar (20)

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertility
 
Adenxal mass guidelines2020
Adenxal mass guidelines2020Adenxal mass guidelines2020
Adenxal mass guidelines2020
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversy
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gyn
 
FIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVFFIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVF
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicine
 
Infertility prevention
Infertility prevention Infertility prevention
Infertility prevention
 
Female infertility
Female infertility Female infertility
Female infertility
 
Maternal near miss
Maternal near missMaternal near miss
Maternal near miss
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021
 
CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT  CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown location
 
Aerobic Vaginitis
Aerobic Vaginitis Aerobic Vaginitis
Aerobic Vaginitis
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021
 
Imaging in pregnancy 2 in1
Imaging in pregnancy 2 in1Imaging in pregnancy 2 in1
Imaging in pregnancy 2 in1
 
update on PCOS
update on PCOSupdate on PCOS
update on PCOS
 
PREECLAMPSIA‐ECLAMPSIA SPECTRUM
PREECLAMPSIA‐ECLAMPSIA SPECTRUMPREECLAMPSIA‐ECLAMPSIA SPECTRUM
PREECLAMPSIA‐ECLAMPSIA SPECTRUM
 
Ovarian cysts and infertility
Ovarian cysts and infertilityOvarian cysts and infertility
Ovarian cysts and infertility
 

Recently uploaded

Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?
Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?
Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?DrShinyKajal
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxpalsonia139
 
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale nowSherrylee83
 
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON  .pptxDIGITAL RADIOGRAPHY-SABBU KHATOON  .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptxSabbu Khatoon
 
Denture base resins materials and its mechanism of action
Denture base resins materials and its mechanism of actionDenture base resins materials and its mechanism of action
Denture base resins materials and its mechanism of actionDr.shiva sai vemula
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...marcuskenyatta275
 
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materialsSherrylee83
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...marcuskenyatta275
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenRaju678948
 
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...marcuskenyatta275
 
A thorough review of supernormal conduction.pptx
A thorough review of supernormal conduction.pptxA thorough review of supernormal conduction.pptx
A thorough review of supernormal conduction.pptxSergio Pinski
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...Ayman Seddik
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Health Kinesiology Natural Bioenergetics
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answersShafnaP5
 
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...PhRMA
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUELMKARTHIKEMMANUEL
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifierNidhi Joshi
 
PREPARATION FOR EXAMINATION FON II .pptx
PREPARATION FOR EXAMINATION FON II .pptxPREPARATION FOR EXAMINATION FON II .pptx
PREPARATION FOR EXAMINATION FON II .pptxPupayumnam1
 

Recently uploaded (20)

Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?
Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?
Case presentation on Antibody screening- how to solve 3 cell and 11 cell panel?
 
Scleroderma: Treatment Options and a Look to the Future - Dr. Macklin
Scleroderma: Treatment Options and a Look to the Future - Dr. MacklinScleroderma: Treatment Options and a Look to the Future - Dr. Macklin
Scleroderma: Treatment Options and a Look to the Future - Dr. Macklin
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
 
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
5CL-ADB powder supplier 5cl adb 5cladba 5cl raw materials vendor on sale now
 
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON  .pptxDIGITAL RADIOGRAPHY-SABBU KHATOON  .pptx
DIGITAL RADIOGRAPHY-SABBU KHATOON .pptx
 
Denture base resins materials and its mechanism of action
Denture base resins materials and its mechanism of actionDenture base resins materials and its mechanism of action
Denture base resins materials and its mechanism of action
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
 
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
5Cladba ADBB 5cladba buy 6cl adbb powder 5cl ADBB precursor materials
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in children
 
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
TEST BANK For Lewis's Medical Surgical Nursing in Canada, 4th Edition by Jane...
 
A thorough review of supernormal conduction.pptx
A thorough review of supernormal conduction.pptxA thorough review of supernormal conduction.pptx
A thorough review of supernormal conduction.pptx
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
 
HyperIgE syndrome: primary immune deficiency.pdf
HyperIgE syndrome: primary immune deficiency.pdfHyperIgE syndrome: primary immune deficiency.pdf
HyperIgE syndrome: primary immune deficiency.pdf
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answers
 
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
Vaccines: A Powerful and Cost-Effective Tool Protecting Americans Against Dis...
 
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUELCONGENITAL HYPERTROPHIC PYLORIC STENOSIS  by Dr M.KARTHIK EMMANUEL
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifier
 
PREPARATION FOR EXAMINATION FON II .pptx
PREPARATION FOR EXAMINATION FON II .pptxPREPARATION FOR EXAMINATION FON II .pptx
PREPARATION FOR EXAMINATION FON II .pptx
 

Covid19 & pregnancy

  • 1. 5/8/2020 ABOUBAKR ELNASHAR 1 COVID-19 & Pregnancy What obstetrician needs to know?  Sexual intercourse  Infertility  ART  Pregnancy Prof. Aboubakr Elnashar Benha university Hospital, Egypt ABOUBAKR ELNASHAR  Vertical transmission (transmission from mother to baby antenatally or intrapartum)  China: no evidence {amniotic fluid, cord blood, neonatal throat swabs, placenta swabs, genital fluid, breast milk samples from infected mothers: negative for the virus}.  RCOG, 2020, 21 April: probability  2 reports: {IgM for SARS-COV-2 in neonatal serum at birth. Since IgM does not cross the placenta,± represent a neonatal immune response to in utero infection}.ABOUBAKR ELNASHAR
  • 2. 5/8/2020 ABOUBAKR ELNASHAR 2 Sexual transmission (UNICEF, 2020)  NO {not found in semen or vaginal fluid}  But: SI involves close contact, kissing& touching, these are the ways of transmitting this virus  Avoid sex if you or your husband (New York City Health, 2020) 1. Confirmed Covid19 2. Suspected Covid 19 3. High risk for severe Covid-19 ABOUBAKR ELNASHAR DIAGNOSIS  Suspected cases (22.4.2020) ABOUBAKR ELNASHAR
  • 3. 5/8/2020 ABOUBAKR ELNASHAR 3 22.4.2020 ABOUBAKR ELNASHAR  Single chest radiograph  Very low fetal radiation dose (0.0005 to 0.01 mGy) Abdominal shielding  CT  should be performed, if indicated  fetal radiation dose is low  Not associated with an increased risk of  fetal anomalies or  pregnancy loss.  Pulmonary ultrasound  quick diagnosis of pneumonia ABOUBAKR ELNASHAR
  • 4. 5/8/2020 ABOUBAKR ELNASHAR 4 ABOUBAKR ELNASHAR EFFECTS ON PREGNANCY 1. Maternal  Not more likely to contract COVID19 1. More severe infection  Pneumonia  Marked hypoxia  In late pregnancy, compared with early pregnancy.  The absolute risks: Small 2. Increased risk of DVT {Reduced mobility from self-isolation at home, or hospital admission} ABOUBAKR ELNASHAR
  • 5. 5/8/2020 ABOUBAKR ELNASHAR 5 2. Effect on the fetus  No increased risk of  Miscarriage or early pregnancy loss  Teratogenicty . 1. Fetal compromise 2. Prelabour PROM 3. Hyperthermia during organogenesis: congenital anomalies, NTD, or miscarriage.(Theoretical) ABOUBAKR ELNASHAR  Yan et al, 2020. 24 April 116 pregnant women withCOVID-19 in China  The most common symptoms  Fever: 50.9%  Cough: 28.4%  No sym: 23.3%.  Abnormal radiologic findings in 96.3% of cases.  Severe pneumonia: 6.9%. no maternal deaths.  PTL: 23.2%  Spontaneous PROM: 6.1%  CS: 85.9%  NICU: 47% Neonatal death: 1%.ABOUBAKR ELNASHAR
  • 6. 5/8/2020 ABOUBAKR ELNASHAR 6 MANAGEMENT  MULTIDISCIPLINARY TEAM 1. Chest specialist 2. Intensivist 3. OBSTETRICIAN 4. Anesthesiologist 5. Neonatologist 6. Microbiologist 7. infection control specialist A. MEDICAL B. OBSTETRICAL ABOUBAKR ELNASHAR A. MEDICAL 22.4.2020 ABOUBAKR ELNASHAR
  • 7. 5/8/2020 ABOUBAKR ELNASHAR 7 ABOUBAKR ELNASHAR OBSTETRICAL I. ANTENATAL CARE (RCOG, 2020)  Appointments  Limited with remote consultation by telephone  Women who have had symptoms  deferred until 7 days after the start of symptoms, unless symptoms (aside from persistent cough) persevere.  Suspected or confirmed COVID-19  delayed until after the recommended period of isolation 14 days ABOUBAKR ELNASHAR
  • 8. 5/8/2020 ABOUBAKR ELNASHAR 8  Antenatal Clinic  Separate for suspected or confirmed COVID-19.  Dedicated team  appropriate PPE.  Dedicated equipment  Remove non-essential items  US machine  decontaminated after each use.  Transducers are cleaned and disinfected  Protective covers for probes and cables. ABOUBAKR ELNASHAR ABOUBAKR ELNASHAR
  • 9. 5/8/2020 ABOUBAKR ELNASHAR 9  Procedures  US & other investigations (urine &blood tests in same visit  US for F growth& anatomy.  Electronic FHR monitoring  Doppler assessment  Amniocentesis  Not recommended in active infection. ABOUBAKR ELNASHAR 2. Use of medications to manage pregnancy  Antenatal betamethasone  CDC: avoiding glucocorticoids in COVID-19- positive { increased risk for mortality}  ACOG: between 24+0 &33+6 w in patients at high risk of PTL within 7 days  Not 34+0 to 36+6 w  {benefits to the neonate are less clear} ABOUBAKR ELNASHAR
  • 10. 5/8/2020 ABOUBAKR ELNASHAR 10  Low-dose aspirin  For prevention of PET.  Suspected or confirmed COVID-19 for whom LDA would be indicated, the decision to continue should be individualized & is usually possible.  Continuing is not worthwhile in  Severely or critically ill patients or  Near term ABOUBAKR ELNASHAR  NSAIDs (ibuprofen)  Early in the course of infection: severe disease  No clinical or population-based data that directly address the risk of NSAIDs.  WHO do not recommend avoiding NSAIDs in COVID-19 patients when clinically indicated  Acetaminophen  In the first trimester  Fever ABOUBAKR ELNASHAR
  • 11. 5/8/2020 ABOUBAKR ELNASHAR 11  Tocolysis  Nifedipine  Not:  Indomethacin, which is subject to the concerns discussed above  Beta sympathomimetics, which can further increase the maternal heart rate. ABOUBAKR ELNASHAR 3. Delivery timing  Depend upon: 1. Mother's clinical status 2. Gestational age 3. Fetal well-being.  Improvement mother's condition: improve fetal status: pregnancies allowed to continue to term.  If woman is critically ill, deterioration : IUF demise or loss of both mother& infant: early delivery  Infectious: Elective CS ± delayed, if possible ABOUBAKR ELNASHAR
  • 12. 5/8/2020 ABOUBAKR ELNASHAR 12  Mg sulfate —  Indication  maternal seizure prophylaxis  neonatal neuroprotection  Women with respiratory compromise {Mg sulfate ±depress respirations}.  Consultation with maternal-fetal medicine& pulmonary/critical care specialists. ABOUBAKR ELNASHAR II.INTRAPARTUM 1. Evaluation of all patients on admission 2. PPE on labor  All clinicians  All asymptomatic patients 3. Mode of delivery  Based on obstetric indications, as there is no clear benefit of delivery via CS  Seriously ill patients & need urgent delivery should be by category 1 CS. ABOUBAKR ELNASHAR
  • 13. 5/8/2020 ABOUBAKR ELNASHAR 13 4. Analgesia & anesthesia  Regional Anasthesia by epidural or spinal  Recommended .  General anesthesia (intubation & extubation)  Considered an aerosolizing procedure  The scrub team should  Scrub & wear PPE (N-95) before the general anesthesia is commenced. ABOUBAKR ELNASHAR  Nitrous oxide  Not recommended  {insufficient data about cleaning, filtering, potential aerosolization of nitrous oxide systems}.  Intravenous, patient-controlled analgesia  limiting use  {risk of respiratory depression}. ABOUBAKR ELNASHAR
  • 14. 5/8/2020 ABOUBAKR ELNASHAR 14 5. Labor management  Person-to person contact & time in the labor unit & hospital should be limited  Maternal observations:  T, RR, oxygen saturation to be kept above 94%.  Fluid chart to avoid fluid overload.  Continuous CTG  Shortening of the second stage ABOUBAKR ELNASHAR  Rupture of membranes&internal FHR monitoring  ±performed, but data are limited  {COVID19 has not been detected in vaginal secretions or amniotic fluid}  Pushing  often causes loss of feces, which can contain the virus & spread the infection  Not delaying pushing in 2nd stage. ABOUBAKR ELNASHAR
  • 15. 5/8/2020 ABOUBAKR ELNASHAR 15  Delayed cord-clamping:  Unlikely to increase the risk of transmitting virus from infected mother to the fetus (ACOG, RCOG, EMH, April 2020)  Oxygen therapy for fetal resuscitation  Should be abandoned {no proven fetal benefit nasal cannula& face mask used are in contact with the maternal respiratory tract& secretions: increases contamination/exposure between pt. &provider}. ABOUBAKR ELNASHAR  Neonate should be  Cleaned& dried immediately  Leaving vernix caseosa in place for 24 h since it contains antimicrobial peptides.  Isolated for 14 days  Closely monitored for clinical manifestations of infection.  The mother & newborn  May need to be isolated separately until both are cleared ABOUBAKR ELNASHAR
  • 16. 5/8/2020 ABOUBAKR ELNASHAR 16 III. Post partum care 1. Placental disposal  The placenta should be treated as biohazardous waste ABOUBAKR ELNASHAR 3. Breast feeding: (EMH, April 2020)  Not recommended.  If the mother is severely or critically ill  express breast milk with a pump to maintain milk production (the pump should be cleaned after each use).  Can be considered  If the mother is asymptomatic or mildly affected, {virus is transmitted by respiratory droplets rather than breast milk}  Mothers should:  wash their hands  wear a mask  avoid coughing or sneezingABOUBAKR ELNASHAR
  • 17. 5/8/2020 ABOUBAKR ELNASHAR 17 5. Postpartum fever  COVID-19 should be part of the dd particularly  respiratory symptoms &  reduced oxygenation.  Such patients should be  tested for the virus  evaluation for common causes of intrapartum &postpartum infection:  Chorioamnionitis  Endometritis ABOUBAKR ELNASHAR 6. Postpartum office visits  Should be limited to reduce the risk of inadvertent exposure.  Early postpartum assessments: wound &blood pressure checks, with telephone.  After 4-8 w: psychological assessment  Screen for postpartum depression: self-report, 10-item Edinburgh Postnatal Depression Scale, which can be completed in 5 minutes  Severe anxiety and support offered.  After 12W: A comprehensive assessment especially in patients with comorbiditiesABOUBAKR ELNASHAR
  • 18. 5/8/2020 ABOUBAKR ELNASHAR 18 TAKE HOME MESSAGE 1. No evidence of miscarriage, F. congenial fetal malformation. 2. It may cause PTL, PPROM, F. compromise 3. ANC should be delayed till the symptoms improve 4. Separate room, dedicated team, appropriate PPE. dedicated equipment 5. Delivery timing depend upon: Mother's clinical status G. age & F. well-being. 6. Mode of delivery based on obstetric indications 7. Regional anasthesia by epidural or spinal 8. The placenta is treated as biohazardous waste 9. Breast feeding not recommended if the mother is severely or critically ill ABOUBAKR ELNASHAR  For CONID 19 AND Pregnancy: The following statements are correct except A. Increased risk of DVT during pregnancy B. It is not sexually transmitted C. Corticosteroid is indicated between 24+0 &33+6 w in patients at high risk of PTL within 7 days D. Oxygen therapy for fetal resuscitation is recommended E. Delayed cord-clamping is unlikely to increase risk of transmitting virus from infected mother to fetus ABOUBAKR ELNASHAR