The transmission of COVID-19 to the baby during pregnancy “is rare” and “the risk of infection of pregnant women is similar to that of the general population”, however, there is “evidence of higher clinical risk, if they contract the disease”, stated today Carlos Veríssimo , member of the board of the Gynaecology-Obstetrics College of the Portuguese Medical Association and director of this specialty service at Hospital Beatriz Ângelo (HBA), in the daily press conference promoted by the General Directorate for Health (DGS). For that reason, DGS issued today general orientation in the sense of applying the new coronavirus test to all pregnant women with symptoms suggestive of COVID-19 or without symptoms, but having had contact with a suspected or confirmed case. It was up to Carlos Veríssimo (on the right, in the photo, with the secretary of state for health, António Sales) to explain the essential aspects of the DGS orientation on the care to provide pregnant women, based on the recommendations of the specialty college of the Medical Association. The physician, who is also obstetrician at Hospital da Luz Lisboa, made a point of beginning by leaving “a note of contained tranquillity to pregnant women”, by stressing that the four cases detected so far are within the estimated statistics. But for pregnant women, presently, “the word of command is social restraint” – which implies that they should work remotely. Otherwise, pregnant women should follow the recommendations made to the general population and, as highlighted by the specialist, “maintain the surveillance recommended by the assisting doctor, including the undertaking of echographies and laboratorial exams”. “We, obstetricians, do not want, at all, non-surveilled or under-surveilled pregnancies. We maintain the two main echographies in obstetric assistance, the echography of the first trimester and the second trimester (the morphological echography)”, he stressed. As to prenatal surveillance, the DGS orientation determines that: Whenever essential procedures of pregnancy surveillance requiring physical presence are not at stake, physicians / health units should privilege teleconsultation and domiciliary self-evaluation of weight and blood pressure. In the case of quarantine, routine exams should, whenever possible, be postponed untill the end of that period, without compromising clinical safety, teleconsultation being advised for medical follow-up. In these contacts, weight and blood pressured should be registered, as well as the presence of foetal movements and the occurrence of contractions or pelvic pain. Procedures that can be postponed, such as the combined screening of the first trimester and the morphological echography, should be scheduled by the health unit to the end of the day. Vaccination should always be maintained (pregnant women without symptoms or with mild symptoms of COVID-19). All pregnant women must be vaccinated against whooping cough (Tdap vaccine), between the 20 th and 36 th weeks of pregnancy, preferably after the morphological echography. In case of infection by COVID-19, and whenever possible, vaccination should occur after the period of infection. As for delivery in pregnant women with COVID-19, “it is recommended to involve the fewest number of interveners” and its completion in an isolated room. “Accompanying third-parties (fathers) are not at all recommended”, further added Carlos Veríssimo. These pregnant women will always be administered the epidural, avoiding as much as possible general anaesthesia, and submitting all new-borns to COVID-19 testing. In these situations, of pregnant women with suspicion or confirmation of COVID-19, breastfeeding is not recommended – a situation that could be, however, weighted on a case by case basis, as justified in the DGS orientation: “The separation between mother and child after birth is a controversial question, for the risk of contagion for the new-born opposes to the advantages of early bonding and breastfeeding.” “Health institutions must take individualized decisions, considering the wish of the mother, the equipment available in the hospital and the availability of health teams.” “When there is no separation between the mother and the child, the mother should carefully wash her hands and put on a surgical mask, before any contact with the new-born.” “There is no sustained evidence of viral transmission risk via breast milk, therefore, in situations of separation between mother and child, it is recommended the extraction of the mother’s milk with a pump, until the mother gets two negative tests.” DGS orientation in full
