Pregnant and postpartum women with COVID-19 should receive supportive care. While pregnant women are not more likely to get infected, those who do contract COVID-19, especially in the third trimester, are at higher risk of severe outcomes. COVID-19 testing criteria are the same for pregnant women as non-pregnant adults. Preventative measures include vaccination, masks, distancing, and hygiene. COVID-19 vaccination is recommended in pregnancy to protect both mother and baby. Mild cases can be isolated at home but moderate or severe cases require hospital admission. Mode of delivery depends on obstetric needs and maternal stability.

1. COVID-19 in pregnant and
postpartum women
Themba Hospital DipObs Tutorials
By Dr N.E Manana

2. Intro
• COVID-19 is a respiratory tract infection caused by coronavirus-
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
• Pregnant and postpartum women with suspected or confirmed
COVID-19 should be managed with supportive care, and consider the
immunologic and physiologic adaptations during and after pregnancy.
• Pregnant women are not at an increased risk of becoming infected
with COVID-19.
• However, pregnant women who contract COVID-19 are likely to have
severe morbidity and mortality, particularly in the third trimester of
pregnancy

3. COVID-19 testing
In pregnant and postpartum women
• Pregnancy does not alter the criteria for testing.
• Pregnant women should be investigated and diagnosed as per local
criteria.
• For pregnant women the same infection prevention and COVID-19
investigation and diagnostic guidance applies, as for non-pregnant
adults

4. Preventative measures
• COVID-19 vaccination is recommended
• Wear a face mask
• Social distancing
• Maintain good personal hygiene: Wash hands, use hand sanitizer
• They should phone their local health facility or the National COVID-19
helpline (0800 029 999/0600123456) to enquire about whether they
should be tested for COVID-19
• Personal protective equipment (PPE) must be used by those working
in the healthcare environment according to local guidelines

5. COVID-19 vaccination policy
For pregnant and postpartum women
• COVID-19 vaccination is recommended in pregnancy.
• Vaccination against COVID-19 should be offered to all pregnant and lactating women,
irrespective of the presence of co-morbidities.
• Pregnant and lactating women are to be immunized with any of the vaccines currently
available in the country.
• Vaccines can be offered at any gestational age in pregnancy and breastfeeding period.
• COVID-19 vaccination should be offered at the same time as the rest of the population
based on age and clinical risk (as per local national guidelines).
• Vaccination of pregnant and breastfeeding women during routine antenatal and
postnatal visits should be encouraged and facilitated.
• Where this is not possible, women should be encouraged to access vaccination at nearby
sites.
• Women planning a pregnancy or fertility treatment can receive the COVID-19 vaccine
and do not need to delay conception.

6. Benefits of getting the COVID-19 vaccine
During pregnancy
• The vaccines are effective at preventing COVID-19 disease, especially
severe disease and mortality.
• Help transfer protective antibodies to the fetus or neonate. This may
decrease the chance of a neonate getting COVID-19.
• Potential reduction in the risk of preterm birth associated with
COVID-19.
• Potential reduction in transmission of COVID-19 to vulnerable
household members.
• Potential reduction in the risk of stillbirth associated with COVID-19

7. Side effects
In pregnant and breastfeeding women
• No additional safety concerns have been reported for vaccinated
pregnant women or their newborns.
• Pregnant women receiving a COVID-19 vaccine show similar common
minor adverse effects to non-pregnant population.
• The rare syndrome of vaccine-induced thrombosis and
thrombocytopenia (VITT) is an idiosyncratic reaction not associated
with any of the usual venous thromboembolism risk factors.
• There is no evidence that pregnant or postpartum women are at
higher risk of VITT.

8. Risk factors for severe COVID-19
• BMI ≥ 30 kg/m2
• Pre- pregnancy co-morbidities (e.g. diabetes or hypertension)
• Maternal age ≥ 35 years
• Socio-economic deprivation
• Working in healthcare or public essential services

9. The effects of maternal COVID-19 on the fetus
• There is no reported increase in congenital anomalies because of COVID-19
infection
• Vertical transmission is rare
• Increased risk of stillbirth
• Increased incidence of small-for-gestational- age babies
• Increased preterm birth rate

10. Investigations
In pregnant and postpartum women
• Pregnancy does not alter the criteria for testing.
• Pregnant women should not be excluded from testing and investigations if clinically indicated.
• COVID-19 PCR testing is the gold-standard with the greatest sensitivity and specificity
• Use of an antigen-detecting rapid diagnostic tests is useful in the setting of pregnant women who may not
be able to plan their admission, and allows immediate isolation of those who are positive.
• Each facility must assess their access to testing and determine which testing strategy is most appropriate
based on local guidelines:
• During a COVID-19 wave, all pregnant women who need admission must be tested for COVID-19 using a
rapid antigen test, conducted on arrival.
• Further management will depend on the rapid antigen test result and the presence or absence of symptoms
suggestive of COVID-19.
• During times when there is no COVID-19 wave, all pregnant women needing admission who screen negative
for COVID-19 symptoms and who can provide evidence that they are fully vaccinated against COVID-19 do
not need a COVID-19 admission test and can be managed as COVID-19 negative.
• They must be screened daily for COVID-19 symptoms.

11. Symptoms of COVID-19 present Symptoms of COVID-19 absent
COVID-19 rapid antigen test positive Admit to designated COVID-19 section of the maternity
unit at the appropriate level of care
Admit to designated COVID-19 section of the maternity
unit
at the appropriate level of care
COVID-19 rapid antigen test negative Do COVID-19 PCR test. Admit to PUI cubicle of maternity
unit until PCR result available
Admit and manage as COVID-19 negative patient. Daily
screening for COVID-19 symptoms

12. COVID-19 symptoms
In pregnant and postpartum women
• There is currently no known difference between the clinical
manifestations of COVID-19 in pregnant and non-pregnant women.
• Most symptomatic women experience mild or moderate cold/flu-like
symptoms
• The most common symptoms of COVID-19 in pregnant women are
cough, fever, sore throat, dyspnoea, myalgia, loss of sense of taste or
smell and diarrhoea.

13. Referral and admission criteria
For women with suspected or proven COVID-19
• Obstetric risk factors or complications needing admission
• Co-morbidities
• Severity of COVID-19 disease (moderate and severe COVID-19 disease)
• Mild COVID-19 disease but, home isolation is not feasible
• Mild COVID-19 disease but monitoring by teleconsultation is not available

14. Level of care
Were pregnant women with COVID-19 should be admitted
• Mild COVID-19 can be managed at home or in a designated isolation facility
if available.
• Moderately severe COVID-19 requiring oxygen by mask to maintain oxygen
saturations above 95% must be managed in a hospital with a maternity
service and a doctor full-time on-site.
• Severe COVID-19 requiring ICU care should be managed at a hospital that
has ICU and or a multidisciplinary team were such services are available
(regional, tertiary, central or private hospital).
• Pregnant women in labour or with obstetric risk factors and complications
must be managed at the appropriate level of care according to existing
obstetric referral criteria.

15. COVID-19 status and
disease severity
Management protocol
COVID-19 confirmed case
with asymptomatic, mild
disease
Isolate at home with healthcare facility surveillance by telemonitoring/SMS/WhatsApp unless other obstetric risk factors, co-morbidities, and social
circumstances require admission.
Provide supportive care: Paracetamol for fever and headache, hydration and rest.
Women should monitor themselves for worsening symptoms and obstetric danger signs during home isolation.
Worsening symptoms include difficulty breathing/talking, coughing blood, chest pain, unremitting fever, dizziness, confusion, and obstetric warning signs.
If present, she should call a local facility or the Helpline 0800 029 999
The emergency services and the receiving facility should be informed that the woman is in self-isolation for COVID-19 so that IPC measures can be
adhered to during transfer and arrival at the facility.
COVID-19 confirmed with
moderate disease
An isolated bed or cubicle in the maternity unit.
Obstetrics management individualised.
Admit to dedicated COVID-19 hospital or wad as per local availability in consultation with a multidisciplinary team.
Supportive care includes:
Oxygen therapy: Maintain SpO2 >94%.
Antibiotics for superimposed infection
Corticosteroid therapy for severe disease
Corticosteroids for fetal lung maturity to be individualised based on the woman’s condition and GA
Venous thromboembolism prophylaxis: low molecular weight heparin/ unfractionated heparin
Hydration and rest
COVID-19 confirmed case
or PUI with severe or
These patients should ideally be transferred to an ICU where specialist or multi-disciplinary care can be provided. Notify the receiving facility before
transfer.
Adhere to ICP and PPE.

16. Method of induction of labour, mode and
timing of delivery
Mode of delivery
• Mode of delivery in pregnant women with COVID-19 should be guided by obstetric indications and physiological stability
(cardiorespiratory status and oxygenation).
Timing of delivery
• Timing of delivery should be individualized and based on the disease severity, associated co-morbidities, and the gestational
age.
• In asymptomatic/mild disease, delivery should be reserved for appropriate obstetric indications and should not be delayed
solely due to COVID-19.
• In severe or critical disease, a multi-disciplinary team should assess and make the clinical decision.
Induction of labour
• COVID-19 infection per se is not an indication for induction of labour.
• Both the indication and the cervical status should be evaluated in pregnant women scheduled for labour induction.
• Those who have an unfavourable cervix (e.g., Bishop score <6) can be induced by mechanical or pharmacological methods as
per the local/hospital protocol.
• Fetal monitoring as per standard guidelines according to obstetric risk factors. Not for fetal monitoring if the mother is unstable.
• Healthy neonates should be allowed to room-in with their mothers. This is very important for the wellbeing of the mother-baby
pair. The mother-baby pair must be isolated from uninfected mothers and neonates.

17. Assessment and management

19. Thank You