Author: Di Mascio, D.; Buca, D.; Berghella, V.; Khalil, A.; Rizzo, G.; Odibo, A.; Saccone, G.; Galindo, A.; Liberati, M.; D'Antonio, F.
Title: Counseling in maternal–fetal medicine: SARSâ€CoVâ€2 infection in pregnancy Cord-id: sba0ezo5 Document date: 2021_5_3
ID: sba0ezo5
Snippet: Severe acute respiratory syndrome coronavirus 2 (SARSâ€CoVâ€2) is a zoonotic coronavirus that crossed species to infect humans, causing coronavirus disease 2019 (COVIDâ€19). Despite a potentially higher risk of pregnant women acquiring SARSâ€CoVâ€2 infection compared with the nonâ€pregnant population (particularly in some ethnic minorities), no additional specific recommendations to avoid exposure are needed in pregnancy. The most common clinical symptoms and laboratory signs of SARSâ€CoV
Document: Severe acute respiratory syndrome coronavirus 2 (SARSâ€CoVâ€2) is a zoonotic coronavirus that crossed species to infect humans, causing coronavirus disease 2019 (COVIDâ€19). Despite a potentially higher risk of pregnant women acquiring SARSâ€CoVâ€2 infection compared with the nonâ€pregnant population (particularly in some ethnic minorities), no additional specific recommendations to avoid exposure are needed in pregnancy. The most common clinical symptoms and laboratory signs of SARSâ€CoVâ€2 infection in pregnancy are fever, cough, lymphopenia and elevated Câ€reactive protein levels. Pregnancy is associated with a higher risk of severe SARSâ€CoVâ€2 infection compared with the nonâ€pregnant population, including pneumonia, admission to the intensive care unit and death, even after adjusting for potential risk factors for severe outcomes. The risk of miscarriage does not appear to be increased in women with SARSâ€CoVâ€2 infection. Evidence with regards to preterm birth and perinatal mortality is conflicting, but these risks are generally higher only in symptomatic, hospitalized women. The risk of vertical transmission, defined as the transmission of SARSâ€CoVâ€2 from the mother to the fetus or the newborn, is generally low. Fetal invasive procedures are considered to be generally safe in pregnant women with SARSâ€CoVâ€2 infection, although the evidence is still limited. In pregnant women with COVIDâ€19, use of steroids should not be avoided if clinically indicated; the preferred regimen is a 2â€day course of dexamethasone followed by an 8â€day course of methylprednisolone. Nonâ€steroidal antiâ€inflammatory drugs may be used if there are no contraindications. Hospitalized pregnant women with severe COVIDâ€19 should undergo thromboprophylaxis throughout the duration of hospitalization and at least until discharge, preferably with low molecular weight heparin. Hospitalized women who have recovered from a period of serious or critical illness with COVIDâ€19 should be offered a fetal growth scan about 14 days after recovery from their illness. In asymptomatic or mildly symptomatic women who have tested positive for SARSâ€CoVâ€2 infection at full term (i.e. ≥ 39 weeks of gestation), induction of labor might be reasonable. To date, there is no clear consensus on the optimal timing of delivery for critically ill women. In women with no or few symptoms, management of labor should follow routine evidenceâ€based guidelines. Regardless of COVIDâ€19 status, mothers and their infants should remain together and breastfeeding, skinâ€toâ€skin contact, kangaroo mother care and roomingâ€in throughout the day and night should be practiced, while applying necessary infection prevention and control measures. Many pregnant women have already undergone vaccination, mostly in the USA where the first reports show no significant difference in pregnancy outcomes in pregnant women receiving SARSâ€CoVâ€2 vaccination during pregnancy compared with the background risk. Vaccineâ€generated antibodies were present in the umbilical cord blood and breast milk samples of pregnant and lactating women who received the mRNA COVIDâ€19 vaccine. Based on the available limited data on the safety of the COVIDâ€19 vaccine in pregnancy, it seems reasonable to offer the option of vaccination to pregnant women after accurate counseling on the potential risk of a severe course of the disease and the unknown risk of fetal exposure to the vaccine. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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