As Coronavirus disease 2019 (COVID 19) is declared a global pandemic. Management of expecting mothers and newborn care becomes a great challenge to the physicians and their families. They should follow the same guidelines as the general population to avoid exposure to the virus as much as possible. Pregnancy does not seem to increase the risk of infection nor accelerate its natural history or the severity of illness. Routine prenatal-antenatal care should be home monitored and telemedicine encouraged as much as possible. Women with comorbidities or at high risk of infection such as a recent history of travel, from a containment zone, history of primary or secondary contact should be closely monitored for symptoms. RT PCR is recommended before labor or one day before elective surgery. Supportive treatment is important in infected patients. Low molecular weight heparin can be used for thromboprophylaxis in severe illness. Data on the use of Remdesivir, hydroxychloroquine, Lopinavir-Ritonavir are limited. There is limited data on the placental transmission of the virus. The newborn should also be immediately be tested following the delivery of a COVID19 pregnant woman. If the newborn is found to be negative, strict hygienic measures according to CDC should be followed to express breast milk. According to WHO, breast milk banks are a safe alternative. Few mothers may prefer to give formula feeds, which can be administered by healthy caregivers. There is limited data regarding the transmission of the virus through breast milk.
2. American College of Obstetricians and Gynecologists. COVID-19 FAQs for obstetricians-gynecologists, obstetrics. Washington, DC: ACOG; 2020. Available at: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics.(Accessed on June1, 2020)
3. Royal College of Obstetricians and Gynecologists. COVID-19 virus infection and pregnancy. Occupational health advice for employers and pregnant women during the COVID-19 pandemic.United Kingdom.2020.Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy. (Accessed on May31,2020)
4. Stokes EK, Zambrano LD, Anderson KN, Ellyn P. Marder, Kala M. Raz, Suad El Burai Felix. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 15 June 2020.
5. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb 7;323(11):1061–9.
6. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020 May 14;41(19):1858.
7. Breslin N, Baptiste C, Miller R, Fuchs K, Goffman D, Gyamfi-Bannerman C et al. Coronavirus disease 2019 in pregnancy: early lessons. Am J Obstet Gynecol MFM. 2020 May;2(2):100111.
8. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Feb 24.
9. Huntley BJF, Huntley ES, Di Mascio D. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstetrics and Gynecology. 2020 Jun.
10. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effects of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcomes: a systematic review. Ultrasound Obstet Gynecol. 2020 May 19:10.1002/uog.22088.
11. Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020 Apr 9;2(2):100118.
12. World Health Organisation.Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).Geneva.16-24 February 2020.Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (Accessed on June 14, 2020).
13. Yan J, Guo J, Fan C, Juan J, Yu X, Li J et al. Coronavirus disease 2019 in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020 Apr 23:S0002-9378(20)30462-2.
14. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020 Mar 11;323(18):1843–4.
15. Dong L, Tian J, He S, Zhu C, Wang J, Liu C et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020 Mar 26;323(18):1846–8.
16. Fang FC, Naccache SN, Greninger AL. The Laboratory Diagnosis of COVID-19-- Frequently-Asked Questions. Clin Infect Dis. 2020 Jun 8.
17. Bryant JE, et al. Serology for SARS-CoV-2: Apprehensions, Opportunities, and the Path Forward. Sci Immunol. 2020 05 19;5(47).
18. US Food and Drug Administration. Emergency Use Authorizations.Maryland.2020.Available from: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations (Accessed on June 16, 2020).
19. Centers for Disease Control and Prevention. Interim Guidelines for COVID-19 Antibody Testing in Clinical and Public Health Settings. Georgia. 2020.Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests-guidelines.html?deliveryName=USCDC_2067-DM29085 (Accessed on May 26, 2020).
20. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Apr;18(4):844-847.
21. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M,et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020 Mar;30(3):269-271.
22. Mulangu S, Dodd LE, Davey RT Jr, Tshiani Mbaya O, Proschan M, Mukadi D et al; PALM Consortium Study Team. A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. N Engl J Med. 2019 Dec 12;381(24):2293-2303
23. Lacroix I, Bénévent J, Damase-Michel C. Chloroquine and hydroxychloroquine during pregnancy: What do we know? Therapie; 2020 May 11:S0040-5957(20)30093-7.
24. Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J et al. Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding. BJOG. 2020 May 5.
25. Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med. 2020 Apr;14(2):193-198.
26. Centers for Disease Control and Prevention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings.Georgia.2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html (Accessed on April 09, 2020).
27. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018 Jun 20;6(6):CD002971
28. WHO. Donor human milk for low-birth-weight infants. Geneva. 2019. Available from: https://www. who.int/elena/titles/donormilk_infants/en/ (accessed April 30, 2020)
29. Natalie Shenker.Maintaining safety and service provision in human milk banking: a call to action in response to the COVID-19 pandemic.Lancet.2020 July 01;4(7)484-485.
30. American academy of pediatrics.Breastfeeding Guidance Post Hospital Discharge for Mothers or Infants with Suspected or Confirmed SARS-CoV-2 Infection.Itasca,IL USA.2020. Available from: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/breastfeeding-guidance-post-hospital-discharge/ (Accessed on June 20, 2020).
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