The transmission of COVID-19 to the baby during pregnancy is rare and the risk of infection for pregnant women is similar to that of the general population. There is, however, evidence of higher clinical risk, if they contract the disease. The studies already done indicate there is no rise in the risk of death for the baby or even direct transmission of the virus to the foetus. There is a possibility of association with an increase in the number of preterm births and with a restriction to foetal growth, but it is still under research. On the other hand, there is no evidence of transmission of the SARS-Cov-2 virus by breast milk. Nevertheless, the decision not to breastfeed is to be considered in the case of puerperal infection, since there is a risk of transmission of the virus to the baby by proximity, that is, in the consequence of the procedures executed by the mother in that moment. What to do, if you are pregnant Follow the general recommendations of prevention and self-protection : social distancing, washing and disinfection of the hands, avoid touching the face, sneeze and cough into a disposable paper tissue or into the elbow. If you are working, remain at home teleworking (if applicable). Pay attention to the same symptoms : dry cough, fever and respiratory difficulty, among others. But, as with a large part of the population, pregnant women infected may not have symptoms. Observe the surveillance and medical follow-up plan even in case of infection, including regular analyses and echographies. Observe the vaccination plan in any case: all pregnant women should be vaccinated against pertussis (Tdap vaccine), between the 20 th and 36 th weeks, preferably after the morphologic echography. In case of infection by COVID-19, and whenever possible, vaccination should occur after the period of infection. Criteria for COVID-19 testing, isolation and hospitalization: The new coronavirus test will be made to all pregnant women presenting symptoms suggestive of COVID-19 or without symptoms, but having been in contact with a suspicious or confirmed case of infection. In case of infection , if medical orientation is in that sense, the pregnant woman should stay at home, in isolation, and observe the indications provided. The professionals of the health unit that ensure the following-up of the pregnancy must make available ways of contact and domiciliary follow-up (a decision to be evaluated with caution, on a case by case basis, and considering the conditions of habitability and isolation feasibility, as well as the risk of transmission of the disease to other co-inhabitants). In situations of severe symptoms or other obstetric complaints considered as severe and / or urgent, the pregnant woman should resort immediately to hospital emergency. Hospitalization , if necessary, will be made in isolation, according to the obstetric or infectious criteria. In case of infection or suspicion of infection, what changes? Whenever the essential procedures of pregnancy surveillance requiring the personal presence are not at stake, physicians / health units should privilege tele consultation and domiciliary self-evaluation of weight and blood pressure. In case of quarantine, with mild symptoms or no symptoms, the pregnant woman should measure her body temperature and monitor symptoms of respiratory difficulty. Routine exams should, whenever possible, be adjourned until the end of that period, without compromising clinical safety and recommending tele consultation for the medical following-up. In those contacts, weight and blood pressure must be registered, as well as the presence of foetal movement and the occurrence of contractions or pelvic pain. Procedures that cannot be adjourned, such as the combined screening of the first trimester and the morphologic echography, should be scheduled at the end of the day. Pregnant women cured of the infection must be seen in consultation 14 days after the manifestation of the symptoms and do an echography between two to four weeks after the cure is established. How to proceed with delivery in case of pregnant women with COVID-19? It should be done in an isolated room and with the fewest interveners possible; The presence of third-parties (accompanying persons) is not at all recommended; Epidural should always be administered, avoiding general anaesthesia as much as possible; When the pregnant woman has serious respiratory difficulties, with expected complications for the mother or the baby, a C-section will be performed; After birth, skin to skin contact between mother and baby is advised against. The new-born must do COVID-19 testing and receive neonatal care during the first month of life; After the delivery, for precaution, breastfeeding is not recommended, due to the risk of contagion during the procedures executed by the mother in that moment. This decision, however, should be taken case to case, considering the wish of the mother and the availability in terms of hospital equipment and health team. Author : Carlos Veríssimo Meet the Obstetrics-Gynecology team of Hospital da Luz network . These recommendations were adapted on basis of the orientation issued by the Ordem dos Médicos and Direção Geral da Saúde, available here . Click here for more information and advice of Hospital da Luz about the novel coronavírus COVID-19 epidemic . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
