Updated slides with POGS Practice Bulletin on COVID-19 Vaccination in Pregnant and Breastfeeding Women

1. COVID-19 IN PREGNANCY
Helen V. Madamba, MD MPH-TM DHPEd FPOGS FPIDSOG
Chief Implementer, VSMMC COVID-19 Health Facility

2. https://www.psmid.org/philippine-covid-19-living-recommendations/

4. DIAGNOSIS ON COVID-19 IN PREGNANCY

5. SUSPECT
• Acute respiratory
tract infection
• Close contact with
COVID-19 case
• Absence of
alternative diagnosis
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
PROBABLE
• Suspect case
• Inconclusive
laboratory result
CONFIRMED
• With laboratory
confirmation of virus
causing COVID-19
infection

6. CLOSE CONTACT
•direct physical
contact with a
COVID-19 case
•for 15 minutes
•within 2 meter
distance
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

7. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html
THE DELTA VARIANT
• causes more infections and
spreads faster than early
forms of SARS-CoV-2
• cause more severe illness
than previous variants in
unvaccinated people
• unvaccinated people
remain the greatest
concern.
• fully vaccinated people
with Delta variant
breakthrough infections
can spread the virus to
others

9. Common Clinical Features of COVID-19
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

10. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

11. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

12. Sethuraman, et al.

13. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

14. Recommendation Actions based
on Rapid Antibody Test
Symptom IgM IgG Recommended Action
(-) (-) (-) Adhere to quarantine protocols implemented in
the area
(-) (+) (-) Isolate for 14 days then repeat; if HCW, swab for
RT-PCR
(-) (+) (+) Considered recovered, no RT-PCR testing needed
(-) (-) (+) Considered recovered, no RT PCR testing needed
(+) regardless regardless
Isolate and swab
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

15. Clinical Significance of IgM/IgG Serological Test
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

16. CXR, Chest CT and lung ultrasound
•Not recommended as screening tool in
asymptomatic to mild cases.
•The most common features include lobar, multi-
lobar, or bilateral lung consolidation
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

17. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

18. Ground glass opacities
GGO, smooth and
irregular interlobular
septal thickening,
crazy paving pattern,
air bronchogram and
irregular pleural
thickening
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

19. For Rapid Antigen
Test Kits to be used
in COVID-19 testing,
the World Health
Organization
recommends a
minimum sensitivity
and specificity of
80% and 97%,
respectively.
https://ritm.gov.ph/covid-19-kit-evaluation/completed-evaluations/sars-cov-2-rapid-antigen-ag-test/

20. For Rapid Antigen Test Kits:
sensitivity of 80% and specificity of 97%
https://ritm.gov.ph/covid-19-kit-evaluation/completed-evaluations/sars-cov-2-rapid-antigen-ag-test/

21. EFFECT OF PREGNANCY ON COVID-19

22. NO
Are pregnant patients at higher risk of
getting covid-19?

23. Are pregnant patients at higher risk of
getting covid-19?
Pregnant women DO NOT
appear to have an increased
risk of acquiring COVID-19
infection.

24. Are pregnant patients at higher risk
of getting covid-19?
BUT

25. EFFECT OF COVID-19 ON PREGNANCY

26. MANAGEMENT OF PREGNANT PATIENTS WITH COVID-19
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
Thrombosis UK. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected
with COVID-19. 2020 [Available from: https:// thrombosisuk.org/covid-19- thrombosis.php] accessed 07 April 2020

27. Donders F, Lonnée-Hoffmann R, Tsiakalos A, Mendling W, Martinez de Oliveira J, Judlin P, Xue F, Donders GGG, ISIDOG Covid-Guideline Workgroup. ISIDOG
Recommendations Concerning COVID-19 and Pregnancy, Diagnostics (Basel). 2020;10(4) Epub 2020 Apr 22.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

28. Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus
Infections and Pregnancy Outcomes. Arch Pathol Lab Med 2020
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

29. MANAGEMENT OF COVID-19 IN PREGNANCY

30. American College of Obstetricians and Gynecologists (ACOG) COVID-19 FAQs for Obstetrical care on ObG Project COVID-19: Pregnancy Guidelines. and ACOG
Guidelines on Uptodate at https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

31. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, Fan S, Feng L, Gao Y, He F, He J, Hu Y, Jiang Y, Li Y, Li J, Li X, Li X, Lin K, Liu C, Liu J, Liu X, Pan X, Pang Q, Pu M, Qi H, Shi C,
Sun Y, Sun J, Wang X, Wang Y, Wang Z, Wang Z, Wang C, Wu S, Xin H, Yan J, Zhao Y, Zheng J, Zhou Y, Zou L, Zeng Y, Zhang Y, Guan X. Expert consensus for managing
pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet. 2020;149(2):130. Epub
2020 Apr 1.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

32. Indications for Delivery with
Severe COVID-19 Infection
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

33. Berghella Vincenzo. Coronavirus disease 2019 (COVID-19): Pregnancy issues. Uptodate May 8, 2020
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

34. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance 13 March 2020.
https://www.who.int/publications-detail/clinical-management-of-severeacute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected (Accessed on April 10, 2020).
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

35. Intubation and extubation during general anesthesia are
considered aerosol generating procedures which may
contribute to spread of the virus and should therefore be
avoided in COVID-19 pregnant patients.
Royal College of Obstetrics and Gynecology (RCOG) Coronavirus (COVID-19) Infection in Pregnancy: information for Healthcare Professionals Version 8
[Internet]. 2020 April 17 available from https://www.rcog.org.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

36. American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), Pregnancy and Breastfeeding. https://www.acog.org/ (Accessed on March 25, 2020).
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

37. Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Statement on Coronavirus 2019 (COVID-19). March 10, 2020.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

38. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

39. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

40. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

41. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

42. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

43. INFECTION PREVENTION CONTROL FOR
COVID-19 IN PREGNANCY

44. WARD 11 WARD 3A
ANNEX A
ANNEX B
WARD 3B
OBGYN
RENAL
UNIT
WARD 10
EREID NORTH
DISTRICT
SURGERY
HOLDING
AREA
WARD
9
WARD
8
ER
PHIC WARD
WARD 7
CFI
WARD 4B
ARI
CLINIC
MAIN OR
OPD
SURGERY
PAVILION
PINK CENTER
CHILD
SURVIVAL
WARD 1 & 2
HVMADAMBA2020

45. VSMMC TRIAGE TO COVID-19 TEAM
(+) history of fever or respiratory
symptoms
(+) history of exposure/contact with
COVID-19
(+) geographic origin from an area with
evidence of sustained local transmission

46. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City

47. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City

48. OBGYN ILI UNIT - OBAS
HVMADAMBA2020

49. OBGYN ILI UNIT - OBOR
OB/OR:
2 OR OPEN 24/7
for Emergency CS
HVMADAMBA2020

50. COVID-19 VACCINES
FOR PREGNANT
PATIENTS

51. Information to give pregnant women when offering
COVID-19 vaccination

52. COVID-19 vaccination is recommended to all pregnant and
lactating mothers.
Safe in the first trimester of pregnancy.
No adverse maternal or fetal effects.
No pregnancy test required.
Approved for use: Pfizer, Moderna, Sinovac, Astra Zeneca, J
and J and Gamaleya
COVID-19
Vaccination
in Pregnant
and Lactating
Women

54. COVID-19 IN PREGNANCY