PHILADELPHIA – During a time of COVID-19 precautions and isolation, pregnancy, especially high-risk pregnancies, which usually require more frequent in-office monitoring, presents a particular challenge for mom and healthcare provider. To allay fears and provide clear guidance, the division of Maternal Fetal Medicine at Jefferson Health published recommendations today in one of the leading journals in the field, The American Journal of Obstetrics & Gynecology MFM.
“Pregnant women might be at increased risks from complications from COVID-19. In particular, if they get pneumonia, they are at increased risks of miscarriage, preterm birth, preeclampsia, and their babies of stillbirth and neonatal death, as well as admission to intensive care unit” says senior author Vincenzo Berghella, MD, director of the division of Maternal Fetal Medicine at Jefferson Health. “Pregnant women should try to remain at home as much as possible, as should those in the same home; therefore we are decreasing as much as possible in-person prenatal visits, and using instead telehealth, keeping in touch closely with them via web.”
The majority of the recommendations involve reducing the number of visits that pregnant women should make, asking moms to monitor their blood pressure if possible, and report those numbers to physicians via telehealth visits. “There’s a lot we can still do via telehealth. Many patients are surprised, but with a few basic tools, like the blood pressure cuff if a patient can get one, ability to access their medical records online, and of using telehealth, we can get a good picture of the mom and baby’s health in a normal pregnancy,” says Dr. Berghella.
Other visits, such as those to measure a baby’s growth and check for abnormalities, should be combined whenever possible with in-person visits and laboratory tests to limit a new mom’s potential exposure.
Some of the specific guidelines outlined in the report:
Each patient should be called to decide on need for next in-person visit and/or test.
No support person to accompany patient to outpatient visits or possibly delivery unless they are an integral part of patient care; use video to involve significant others.
Pregnant women with any flu-like symptoms should get a COVID-19 test, especially if there are additional risk factors.
Create separate areas for patients who may have COVID-19, and disinfect all areas and surfaces regularly.
Modify frequency of non-stress tests for high-risk pregnancies where possible.
Patients with gestational diabetes or preeclampsia should plan weekly visits with daily blood-pressure checks at home, with all labwork done at the time of in-person visit.
For some patients, such as those with higher maternal age or BMI greater than 40 but no other risk factors, consider kick counts instead of formal non-stress test.
“We know that these recommendations won’t cover every situation,” says Dr. Berghella. “In areas with a higher COVID-19 incidence more restrictive measures will be likely be appropriate. This guidance is changing daily, in fact hourly. Stay tuned”
Article Reference: Rupsa C. Boelig, MD, MS, Gabriele Saccone, MD, Federica Bellussi, MD, Vincenzo Berghella, MD, “MFM Guidance for COVID-19,” American Journal of Obstetrics & Gynecology MFM, DOI: 10.1016/j.ajogmf.2020.100106, 2020.
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