Scan should be offered without delay in cases of abdominal/pelvic pain with no previous scan showing live intrauterine pregnancy, heavy bleeding with systemic symptoms or high suspicion of ectopic pregnancy. In cases of moderate bleeding or resolved heavy bleeding, it is suggested to use teleconsultation and ask the patient to take a pregnancy test. If […]
Delayed umbilical cord clamping does not seem to increase pathogens transmission. Leaving vernix caseosa in place 24h after birth can be considered due to the presence of antimicrobial peptides. The majority of neonatal infections are caused by the environment and droplet transmission from the mother and other relatives. Physical separation at birth can be considered […]
Indications for immediate assessment : Acute persistent pelvic pain, to rule out ovarian torsion, ruptured ovarian cyst, PID and tubo-ovarian abscess; Suspicion for postoperative complications or hyperstimulation syndrome; Abdominopelvic mass provoking systemic symptoms; AUB causing hemodynamic instability or severe anemia. Indications to delay scan for 2-4 weeks : Risk for malignancy : family history […]
Limitation of surgical services Surgical services need to be limited in this setting. The decision to maintain or cancel a procedure depends on many factors: level of urgency, morbidity/mortality risks of contracting COVID-19 for the patient, impact on hospital bed capacity, risk of community transmission and access to PPE. Urgent procedures cannot be cancelled: ruptured […]
Antenatal corticosteroids for fetal lung maturation Studies that have shown worse outcomes for infected patients with the prolonged use of high-dose corticosteroids did not consider baseline morbidity. However, in an antenatal setting, the doses are much smaller and the exposure is not prolonged. Antenatal steroids must be used with prudence particularly in critically ill pregnant […]
Symptomatic and asymptomatic pregnant women should be tested if they have travelled to an affected country or have been in close contact with a person who tested positive for the disease within the last 14 days. The number of visits to the hospital needs to be reduced to the minimum. It is suggested to try […]
Confirmed cases should be treated in a negative pressure isolation room when available. Critically ill patients should be placed in left lateral decubitus. Treatment options include oxygen therapy, hydration, and empirical antibiotic therapy. The use of antiretroviral therapy and chloroquine is under investigation. Target saturation is ≥ 95%. Is hydroxychloroquine safe in pregnancy? Some […]
Epidemiology : Epidemiological and transmission tendencies are like those seen in non-pregnant adults. Consistent with findings in non-pregnant adults, the cases were predominantly classified as mild or common in terms of severity. Lag time between onset of symptoms and diagnosis was directly related to the severity of the infection. Transmission via the reproductive system […]
A case of diffuse cutaneous lesions occurred on day 10 postpartum in a 37-year-old woman with no history of dermatological or internal disorders or allergies. Delivery was uncomplicated. Lesions appeared 3 days after the onset of general symptoms, and were described as: “Erythematous maculopapular lesions on the trunk, neck and face” “Nummular erythematous lesions with […]
General considerations : A balance between adequate individualized treatment and limited risk of exposure needs to be established. Where possible, telecommunication should be prioritised for appointments. If an in-hospital visit is necessary, the patient should preferably come alone. Interventions such as labs and imaging studies could be postponed if the risk for recurrent/still present disease […]
Some evidence show that at-home medical abortion is preferable to other methods for pregnancy <9 weeks. Safety and efficiency of different methods are comparable. When surgical abortion is necessary, local anesthesia should be preferred to OR and general anesthesia. Phone call and video conference should be prioritised for necessary appointments. If in-hospital abortion necessary, probable […]
General considerations : The number of visits needs to be minimal and the patient should come alone. Triage based on risk factors and temperature at arrival should be performed before the patient enters the ultrasound unit. Non-urgent appointments should be postponed for 14 days. Monochorionic twin pregnancy should be managed as usual. Some high-risk pregnancy […]
Clinical manifestations : Clinical manifestations in pregnant women were comparable to those seen in infected non-pregnant adults. Initial normal body temperature was seen more commonly in pregnant women, thus rendering early detection of the virus more difficult in this population. It has not been shown that pregnancy is a risk factor for more severe infection. […]
There is no consensus between the national organisations (SOGC, RCOG) The RCOG states pregnant women with more than 28 weeks of gestation (final trimester) or that have underlying health conditions should avoid direct contact with patients and are recommended to work from home and limit social contact. The SOGC states that pregnant women in essential […]
Labour Analgesia Early initiation of neuraxial analgesia can help prevent aggravation of respiratory symptoms due to labour pains and can minimize the use of general anesthesia in intrapartum Caesarean section. Neuraxial procedures that involve puncturing dura mater may minimize the need for rescue general anesthesia in cases of urgent Caesarean section; consider CSE or DPE. […]
Recommendations for diagnosis and treatment Diagnostic testing for low-grade cervical cancer on screening can be deferred 6-12 months. LSIL, ASC-US, high-risk HPV with normal cytology Low-grade intraepithelial lesion on biopsy (cervical/vaginal/vulvar) Diagnostic testing for high-grade cervical cancer on screening should be done within 3 months. Procedures for high-grade cervical disease should be done within 3 […]
Inductions in asymptomatic patients should not be rescheduled unless extreme healthcare system burden. Induction can be conducted as usual (Foley catheter and misoprostol or oxytocin infusion) Foley ripening can be done in an outpatient setting in low risk pregnancies. Hospital births are preferred to homebirths when infection status is positive or unknown. Universal nasopharyngeal testing […]
Telehealth is advised for outpatient consultations. Suspension of fertility treatments is recommended by many societies in order to practice social distancing and endorse the redistribution of healthcare resources. Deferment of new treatment cycles, IVF retrievals and embryo transfers, IUI, noncritical gamete cryopreservation, elective surgeries and non-urgent diagnostic procedures is advised. Continuation is justified for “in-cycle” […]
