Update: COVID-19 Pregnancy and Delivery

We've been getting lots of questions about coronavirus, or COVID-19 infection, in pregnancy so we put together this blog post to address the TOP 5 questions we've been getting. And if you're more of a video kind of learner, check out our new YouTube video shared today where we touch on the same content! 

Should I delay trying to conceive? 

 The short answer is we don’t know. 

There is NO definitive evidence that covid-19 infection is associated with increased risk of early pregnancy loss or fetal malformations, though we do know that elevated temperatures in early pregnancy can be associated with fetal malformations, so there is that possible risk. 

 The Canadian Fertility and Androgony Society have released a statement indicating that they are recommending suspending all ART procedures (ovulation inductions and IVF) until further notice. 

Additionally, the American Society for Reproductive Medicine has also issues a similar statement recommending all fertility providers suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation. 

An additional concern with early pregnancy during the COVID-19 outbreak includes the possibility of miscarriage requiring surgical management which could be more difficult to access as hospitals may become overwhelmed with managing patients with COVID-19 illness. 

This discussion really has to be individualized as the decision to delay trying to conceive is so personal and based on so many different factors. If you’re thinking of getting pregnant, talk to your primary care provider today - we’re all here and available, mostly by telehealth! 

Is there a risk of vertical transmission? 

The short answer, we need more studies. 

Vertical transmission is when a pregnant mom gets infected with a virus and then passes that virus to the baby while she is still pregnant. 

We need to remember with this virus it’s SO new and the numbers are still so small, and often papers are being released in pre-proof stages which can lead to confusion and mis-interpretation. 

There have been a few new studies published in JAMA (Journal of the American Medical Association) that showed some babies tested for COVID-19 after delivery were positive shortly after delivery. One study ‘postulates’ that maternal-fetal transmission can’t be ruled out but doesn’t show any clear evidence of vertical transmission. 

The other study tested baby’s blood for SARS-CoV-2 IgG (an immune globulin we know CAN cross the placenta) as well as for IgM, a marker of more recent infection, (which is thought NOT to cross the placenta, but this isn’t always the case.) HOWEVER, these babies ALL had negative PCRs on blood and throat/NP swabs. So it’s POSSIBLE that there could be vertical transmission, this evidence is not definitive and more studies are needed. 

So what does this mean? There is still NO clear evidence of vertical transmission (the infection crossing the placenta and infecting the fetus). However, we still recommend routine precautions including social distancing, self-isolation at a minimum from 36 weeks gestation, practicing diligent hand washing and non-face touching to reduce your risk of getting COVID-19. 

What precautions do I need to take as a pregnant woman?

As the studies continue to be published, we continue to be reassured that pregnant women do not seem to be at higher risk than non pregnant women both at contracting the virus or getting more severe disease. 

Now, it’s important to remember that this doesn't mean we are low risk, just not at higher risk and this is still an infectious virus with a reproductive factor thought to be somewhere between 2 - 3 and a death rate that is significantly higher than influenza. So we need to continue to practice social distancing, self isolation by 36 weeks and diligent hand hygiene. 

I’m pregnant and I’m a front line worker - what should I do? 

Given what we know, though again remember that this disease is still in its infancy (pardon the pun), according to the SOGC (Society of Obstetricians and Gynecologists of Canada) pregnant women in essential services, including health care workers (HCW), can continue to work during the COVID-19 pandemic. In situations where a worker may be exposed to a person who is suspected or confirmed to have COVID-19, appropriate personal protective equipment should be used. No additional PPE measures are required for pregnant HCW beyond those that are advised for non-pregnant HCW. 

However, given the known increased risk of preterm delivery in pregnant women who contract COVID 19 and the lack of clear evidence around vertical transmission I think it’s prudent for us to advocate for our pregnant patients and to have discussions around perhaps transitioning them away from the higher risk clinical situations when they are in the third trimester of their pregnancies. 

What changes are happening at the hospital? 

This is a question a lot of women have, and the answer is going to be different depending on where you live so we can only speak to what is happening where we work and the reasoning behind it. 

So, in terms of inductions of labour those are continuing in the same fashion and we are still trying to do as many outpatient inductions as are appropriate. 

In terms of coming into hospital for your labour and delivery, there are some new restrictions in place including no access to entonox for risk of possible aerosolization (no good evidence for this but no clear evidence against). The bottom line is we don’t know for sure, and until we do we need to be safe to protect our patients, their partners and our staff. 

There are also strict rules right now in terms of the number of people that can be present during your delivery. At present, you are allowed one support person and this person can be whoever you choose. The safest choice is someone who has been self isolating and social distancing. The reasons for this are many. For starters, we don't know how far droplets can travel during the second stage of labour when women are breathing incredibly hard and often at times vomiting; until there is clear evidence one way or another, we need to do what is safest for our patients and our staff. 

The second reason is we need to continue to practice social distancing, and that is hard enough to do even with as few as 2-3 people in the room. We know social distancing is effective at reducing transmission, we in BC are lucky enough to see evidence of that; and unfortunately delivery is no different. We need to continue to follow best practices and social distancing means as few people in the room as necessary during your delivery. 

The third reason is the concern of asymptomatic transmission. There is a lot of buzz about this right now, and the evidence is growing. In fact, recent case series from New York demonstrated that 2 asymptomatic pregnant women were admitted to hospital for obstetric reasons and only began to show symptoms after admission; the thought is that they were likely infected at time of admission and came into contact with anywhere from 15-20 staff members prior to their confirmed diagnosis who were not wearing droplet precautions. 

At this point in time, we don’t have enough evidence to show that we should be wearing droplet precautions for all patient interactions nor do we likely have enough personal protective equipment to do this. But what we can control is the number of people a potentially asymptomatic patient comes into contact with by limiting the number of people in the delivery room. 

As it stands right now, if you need to go for a cesarean section in labour your partner can still be present; thought not if you have COVID-19. Again, this is today. Things can change. 

Your partner can still stay with you post partum for now. If they must leave, they can but we really ask that you minimize coming and going. You can’t have any other visitors, but we are doing our best to get you discharged as soon as you feel ready. You can still bring your own food, but won’t have access to a fridge so you’d need to keep that in mind. 

If your baby is admitted to NICU, right now both you and your partner can visit; tho again we really do recommend to minimize coming and going and it may change so that you can only visit one at time. 

Things are evolving rapidly. But just know this. We are following the science, what science we do have. We are doing this for your safety. For the safety of your family. For the safety of our healthcare providers. For the safety of the community. We know it’s not what you planned. We know you’re scared. We’re here for you. We are all in this together. 

We hope you found this helpful, if you did feel free to share with your network. 

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