SPECIAL ARTICLE
Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals
Liona C. Poon,
Huixia Yang,
Anil Kapur,
Nir Melamed,
Blami Dao,
Hema Divakar,
H. David McIntyre,
Anne B. Kihara,
Diogo Ayres-de-Campos,
Enrico M. Ferrazzi,
Gian Carlo Di Renzo,
Moshe Hod,
Liona C. Poon
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
These authors contributed equally
Search for more papers by this authorHuixia Yang
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
These authors contributed equally
Search for more papers by this authorAnil Kapur
World Diabetes Foundation, Bagsværd, Denmark
These authors contributed equally
Search for more papers by this authorNir Melamed
Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorH. David McIntyre
Mater Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
Search for more papers by this authorAnne B. Kihara
African Federation of Obstetricians and Gynecologists, Nairobi, Kenya
Search for more papers by this authorDiogo Ayres-de-Campos
Department of Obstetrics, Faculty of Medicine, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
Search for more papers by this authorEnrico M. Ferrazzi
Regional Authority of Lombardi, IRCCS Foundation Ca’ Granda Ospedale Maggiore Polyclinic, Mangiagalli Centre, University of Milan, Milan, Italy
Search for more papers by this authorGian Carlo Di Renzo
Center of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
IM Sechenov First State University, Moscow, Russia
Search for more papers by this authorCorresponding Author
Moshe Hod
Mor Women's Health Care Center, Tel Aviv, Israel
FIGO – Chair, Pregnancy and NCDs Committee, Tel Aviv, Israel
Correspondence
Moshe Hod, Mor Women's Health Care Center, Tel Aviv, Israel.
Email: [email protected]
Search for more papers by this author
Liona C. Poon,
Huixia Yang,
Anil Kapur,
Nir Melamed,
Blami Dao,
Hema Divakar,
H. David McIntyre,
Anne B. Kihara,
Diogo Ayres-de-Campos,
Enrico M. Ferrazzi,
Gian Carlo Di Renzo,
Moshe Hod,
Liona C. Poon
Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
These authors contributed equally
Search for more papers by this authorHuixia Yang
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
These authors contributed equally
Search for more papers by this authorAnil Kapur
World Diabetes Foundation, Bagsværd, Denmark
These authors contributed equally
Search for more papers by this authorNir Melamed
Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorH. David McIntyre
Mater Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
Search for more papers by this authorAnne B. Kihara
African Federation of Obstetricians and Gynecologists, Nairobi, Kenya
Search for more papers by this authorDiogo Ayres-de-Campos
Department of Obstetrics, Faculty of Medicine, Santa Maria Hospital, University of Lisbon, Lisbon, Portugal
Search for more papers by this authorEnrico M. Ferrazzi
Regional Authority of Lombardi, IRCCS Foundation Ca’ Granda Ospedale Maggiore Polyclinic, Mangiagalli Centre, University of Milan, Milan, Italy
Search for more papers by this authorGian Carlo Di Renzo
Center of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
IM Sechenov First State University, Moscow, Russia
Search for more papers by this authorCorresponding Author
Moshe Hod
Mor Women's Health Care Center, Tel Aviv, Israel
FIGO – Chair, Pregnancy and NCDs Committee, Tel Aviv, Israel
Correspondence
Moshe Hod, Mor Women's Health Care Center, Tel Aviv, Israel.
Email: [email protected]
Search for more papers by this authorAbstract
In response to the World Health Organization (WHO) statements and international concerns regarding the coronavirus disease 2019 (COVID-19) outbreak, FIGO has issued comprehensive guidance for the management of pregnant women.
References
- 1Su S, Wong G, Shi W, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol. 2016; 24: 490–502.
- 2Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003; 348: 1953–1966.
- 3Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012; 367: 1814–1820.
- 4 World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. https://www.who.int/csr/sars/country/table 2004_04_21/en/. Accessed March 25, 2020.
- 5 World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). 2019. http://www.who.int/emergencies/mers-cov/en/. Accessed March 25, 2020.
- 6Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004; 191: 292–297.
- 7Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet. 2020; 395: 565–574.
- 8van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020; [Epub ahead of print].
- 9 World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed March 9, 2020.
- 10 World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19. 2020 [website]. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—3-march-2020. Accessed March 7, 2020.
- 11Wu JT, Leung K, Bushman M, et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med. 2020. https://doi.org/10.1038/s41591-020-0822-7. Accessed March 25, 2020.
- 12Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497–506.
- 13Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus infected pneumonia in Wuhan, China. JAMA. 2020; [Epub ahead of print].
- 14Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; [Epub ahead of print].
- 15Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: A systematic review and meta-analysis. Int J Infect Dis. 2020; [Epub ahead of print].
- 16Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020; [Epub ahead of print].
- 17Cao B, Wang Y, Wen D, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020; [Epub ahead of print].
- 18Siston AM, Rasmussen SA, Honein MA, et al. ; Pandemic H1N1 Influenza in Pregnancy Working Group. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010; 303: 1517–1525.
- 19Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect. 2019; 52: 501–503.
- 20Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020; 395: 809–815.
- 21Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCov pneumonia. Transl Pediatr. 2020; 9: 51–60.
- 22Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020; [Epub ahead of print].
- 23Zhang L, Jiang Y, Wei M, et al. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province [in Chinese]. Zhonghua Fu Chan Ke Za Zhi. 2020; 55: E009.
- 24Lei DWC, Li C, Fang C, et al. Clinical characteristics of pregnancy with the 2019 novel coronavirus disease (COVID-19) infection. Chin J Perinatal Med. 2020; 23: 159–165.
- 25Shaw GM, Todoroff K, Velie EM, Lammer EJ. Maternal illness, including fever and medication use as risk factors for neural tube defects. Teratology. 1998; 57: 1–7.
- 26Oster ME, Riehle-Colarusso T, Alverson CJ, Correa A. Associations between maternal fever and influenza and congenital heart defects. J Pediatr. 2011; 158: 990–995.
- 27Abe K, Honein MA, Moore CA. Maternal febrile illnesses, medication use, and the risk of congenital renal anomalies. Birth Defects Res A Clin Mol Teratol. 2003; 67: 911–918.
- 28Sass L, Urhoj SK, Kjærgaard J, Dreier JW, Strandberg-Larsen K, Nybo Andersen AM. Fever in pregnancy and the risk of congenital malformations: A cohort study. BMC Pregnancy Childbirth. 2017; 17: 413.
- 29Madinger NE, Greenspoon JS, Ellrodt AG. Pneumonia during pregnancy: Has modern technology improved maternal and fetal outcome? Am J Obstet Gynecol. 1989; 161: 657–662.
- 30Chen YH, Keller J, Wang IT, Lin CC, Lin HC. Pneumonia and pregnancy outcomes: A nationwide population-based study. Am J Obstet Gynecol. 2012; 207(288): e1–e7.
- 31Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: Maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. In-Press; https://doi.org/10.5858/arpa.2020-0901-sa.
10.5858/arpa.2020-0901-sa Google Scholar
- 32Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet. 2019; 145(Suppl 1): 1-33. https://doi.org/10.1002/ijgo.12802.
- 33 World Health Organization. Global surveillance for COVID-19 caused by human infection with COVID-19 virus. Interim guidance, https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov). Accessed March 25, 2020.
- 34 World Health Organization. Rational use of protective equipment for coronavirus disease 2019 (COVID-19). Interim guidance. 2020. https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf. Accessed March 8, 2020.
- 35 Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. Accessed March 25, 2020.
- 36Li X, Xia L. Coronavirus disease 2019 (COVID-19): Role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020: 1–7 [Epub ahead of print].
- 37Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. AJR Am J Roentgenol. 2020: 1–6 [Epub ahead of print].
- 38Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology. 2020; [Epub ahead of print].
- 39Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: Algorithms and radiation dose considerations. Radiographics. 2007; 27: 1705–1722.
- 40 National Library of Medicine. Gadopentetate. In: Drugs and Lactation Database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501398/. Accessed March 7, 2020.
- 41Miller RW. Discussion: Severe mental retardation and cancer among atomic bomb survivors exposed in utero. Teratology. 1999; 59: 234–235.
10.1002/(SICI)1096-9926(199904)59:4<234::AID-TERA8>3.0.CO;2-B CASPubMedWeb of Science®Google Scholar
- 42 Committee on Obstetric Practice. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017; 130: e210–e216.
- 43 American College of Radiology. ACR-SPR practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. 2018. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf. Accessed March 10, 2020.
- 44Tremblay E, Thérasse E, Thomassin-Naggara I, et al. Quality initiatives: Guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012; 32: 897–911.
- 45Emerging understandings of 2019-nCoV. Lancet. 2020; 395: 311.
- 46Maxwell C, McGeer A, Tai KFY, Sermer M. No 225-Management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS). J Obstet Gynaecol Can. 2017; 39: e130–e137.
- 47 Centers for Disease Control and Prevention. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Accessed March 8, 2020.
- 48 World Health Organization [Twitter]. 2020. https://twitter.com/WHO/status/1240409217997189128/photo/1.
- 49Boseley S. China trials anti-HIV drug on coronavirus patients. The Guardian. 2020. https://www.theguardian.com/world/2020/feb/07/china-trials-anti-hiv-drug-coronavirus-patients. Accessed March 7, 2020.
- 50 National Institutes of Health. NIH clinical trial of remdesivir to treat COVID-19 begins. 2020. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-remdesivir-treat-covid-19-begins. Accessed March 9, 2020.
- 51Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019; 200: e45–e67.
- 52Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol. 2020; [Epub ahead of print].
- 53Røsjø H, Varpula M, Hagve TA, et al. Circulating high sensitivity troponin T in severe sepsis and septic shock: Distribution, associated factors, and relation to outcome. Intensive Care Med. 2011; 37: 77–85.
- 54Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol. 2016; 32: 431–439.
- 55 World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. Accessed March 15, 2020.
- 56Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol. 2020; [Epub ahead of print].
- 57Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics. 2003; 112: e254.
- 58Qi H, Chen D, Feng L, Zou L, Li J. Obstetric considerations on delivery issues for pregnant women with COVID-19 infection. Chin J Obstet Gynecol. 2020; 55: E001–E001.
- 59Yang H, Wang C, Poon LC. Novel coronavirus infection and pregnancy. Ultrasound Obstet Gynecol. 2020; [Epub ahead of print].
- 60Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020; [Epub ahead of print].
- 61 Society for Obstetric Anesthesia and Perinatology. Interim Considerations for Obstetric Anesthesia Care Related to Covid-19. https://soap.org/education/provider-education/expert-summaries/interim-considerations-for-obstetric-anesthesia-care-related-to-covid19/. Accessed March 25, 2020.
- 62Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev. 2016; 3: CD010406.
- 63Mullins E, Evans D, Viner R, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: Rapid review. Ultrasound Obstet Gynecol. 2020; [Epub ahead of print].
- 64 Centers for Disease Control and Prevention. Coronavirus disease (COVID-19) and breastfeeding. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html. Accessed March 25, 2020.
- 65 Centers for Disease Control and Prevention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html#anchor_1582067966715. Accessed March 8, 2020.
- 66 American College of Obstetricians and Gynecologists. Practice Advisory: Novel Coronavirus 2019 (COVID-19). https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false. Accessed March 8, 2020.
- 67Dørheim SK, Bjorvatn B, Eberhard-Gran M. Insomnia and depressive symptoms in late pregnancy: A population-based study. Behav Sleep Med. 2012; 10: 152–166.
- 68Chua M, Lee J, Sulaiman S, Tan HK. From the frontlines of COVID-19 – How prepared are we as obstetricians: A commentary. BJOG. 2020; [Epub ahead of print].
- 69 Maternal and Fetal Experts Committee, Chinese Physician Society of Obstetrics and Gynecology, Chinese Medical Doctor Association; Obstetric Subgroup, Society of Obstetrics and Gynecology, Chinese Medical Association; Society of Perinatal Medicine, Chinese Medical Association; Editorial Board of Chinese Journal of Perinatal Medicine. Proposed management of COVID-19 during pregnancy and puerperium. Chin J Perinatal Med. 2020; 23: 73–79.
- 70 World Health Organization. Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim guidance. 2020. https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. Accessed March 25, 2020.
- 71 Registered Nursing. Handling hazardous and infectious materials: NCLEX-RN [website]. 2020. https://www.registerednursing.org/nclex/handling-hazardous-infectious-materials/. Accessed March 25, 2020.
- 72 Vanderbilt University Medical Center. Environmental health and safety. Biohazardous waste: segregation, collection and disposal guide[website]. https://www.vumc.org/safety/waste/biological-waste-guide. Accessed March 25, 2020.
- 73 Centers for Disease Control and Prevention. Infection Control. 3. Management of regulated medical waste in health-care facilities. 2015. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/medical-waste.html#i3. Accessed March 25, 2020.
