Novel Coronavirus (COVID-19) in Pregnancy

COVID-19 UPDATE 15/4/2020:

Recent news reports have mentioned possible cases of mothers passing the coronavirus to their unborn babies. Naturally this has caused anxiety to patients, however the overall message is still reassuring. Please see the following comment from RANZCOG:

“There have been a handful of very recent case reports suggesting that the virus may pass from the mother to the baby (vertical transmission). However, this is very early, preliminary data and has not been confirmed. There was no evidence of harm to the babies. Woman should remain reassured, given our extensive knowledge of the impact of the effect of other respiratory viruses, that there is currently no evidence that COVID-19 will harm your baby or cause abnormalities.”

COVID-19 UPDATE 24/03/2020:

In view of the increasing number of cases in NSW, social distancing is critical.  As such, we have instituted the following requirements for patients attending our practice:

  1. Support person: ideally, we would ask pregnant women to attend for their antenatal visit or ultrasound scan alone, as we need to be able to maintain the recommended distance between people in the waiting room.  For women who choose to bring a support person with them, we are only allowing one person per patient.  This is to protect you, other patients and our staff.
  2. Please do NOT bring children to the rooms.  It seems that children are more likely to act as asymptomatic carriers of the virus.  As such and given our high-risk pregnant population, we have had to institute a new policy of no children in our practice.  We hope this will only be a temporary measure and ask for your understanding.  For women who are unable to attend without children, we will need to arrange a telephone antenatal consultation instead.
  3. As before, do NOT attend the rooms if you are unwell, have recently been overseas or have been in contact with a suspected or known case of COVID-19.  Phone the rooms on 1300 460 111 for further instructions.

Why is this virus causing such a problem?

The coronavirus that causes COVID-19 is a new virus.  People do not have pre-existing immunity to it – that’s why so many people are getting sick.  Doctors and scientists are still working out exactly how this virus behaves.

At present, the focus is on minimising the spread of infection.  It’s essential to follow the advice of the Australian Government and NSW Health (see links at the bottom of this page).

Most importantly, if you are worried that you have symptoms of COVID-19, or that you may have been exposed, immediately isolate yourself.  Phone your doctor, Emergency Department or HealthDirect for further instructions.  Do NOT simply turn up to the practice/ED.

Coronavirus COVID-19 in preganancy

What do we know about COVID-19 in pregnancy?

It is difficult to confidently make predictions about COVID-19 in pregnancy.  Because it is a new virus, we don’t have years of experience and data to guide us, like we do for other viruses.  We are relying on colleagues around the world to publish their experiences of treating pregnant women with COVID-19.  So far, the number of published cases of pregnant women is relatively small.  New information is emerging all the time.  So what we understand about COVID-19 today might be different to what we understand in a few weeks’ time.

Having said that, the early information we have is relatively reassuring for pregnant women.  According to the RCOG and RANZCOG, the majority of pregnant women will only experience mild-to-moderate cold & flu symptoms.  COVID-19 does not appear to affect pregnant women more severely than their non-pregnant peers.

There is also no current evidence to suggest that COVID-19 increases the risk of miscarriage, causes infection in the unborn baby or causes fetal abnormalities.  Some babies have been born prematurely, but it’s not yet clear if the mothers went into labour prematurely, or if doctors decided to deliver early because the mother was very unwell.

Why are we still recommending extra caution for pregnant women?

Understand that while COVID-19 will be mild for most women, it still causes severe or critical illness in a proportion of patients.  Severe illness during pregnancy can be harder for doctors to treat, because pregnancy changes the way your body functions – in particular, your heart, lungs and immune system.  A lot of drugs have special risks or have to be avoided in pregnancy.  Doctors can be forced to deliver the baby prematurely, in order to better treat a very sick mother.

Because most cases of COVID-19 in pregnancy have been mild, we don’t yet know enough about the group who do become severely ill.  During past outbreaks of similar coronaviruses, pregnant women who became very unwell were at higher risk of pregnancy complications.

So until we know more, and because of the extra difficulties in treating very sick pregnant women, we are still advising you to be extra careful.

Is there any treatment?

There is currently no medication or vaccination that stops the virus.  Work is ongoing, so this may change.  Medical care is focused on treating the symptoms.

What can I do to protect myself?

Take sensible precautions.

  • The number one tip is to wash your hands regularly.  Rub for 20 seconds with soap and water.  In particular, wash before eating, after using the bathroom and after touching surfaces in public places.
  • Don’t touch your face!  If you must touch your face, wash your hands before and afterwards.
  • Cover your nose and mouth when you cough or sneeze.  Use a tissue and put it in the bin immediately.  If you don’t have a tissue, cough into the crook of your elbow.  (This is called the vampire sneeze because it looks like a vampire pulling his cape across his face).
  • Stay away from anyone who is unwell, in particular anyone who has symptoms of a respiratory infection (fever, cough, fatigue, shortness of breath, congested nose, sore throat, headaches, muscle aches, chills).
  • Stay away from anyone who has recently travelled overseas
  • Practice social distancing:
    • avoid crowds, mass gatherings and crowded places such as shopping malls, cinemas, conferences
    • avoid small gatherings in enclosed spaces, for example family celebrations
    • attempt to keep a distance of 1.5 metres from other people where possible, for example when out and about in public places
    • avoid shaking hands, hugging, or kissing other people
    • avoiding visiting vulnerable people e.g. the elderly, aged care facilities, hospitals, infants, or people with compromised immune systems
    • ask your workplace about the possibility of working from home
  • Healthy people do not need to wear a mask.  There is no proof that wearing a mask protects healthy people from catching the virus.

What do I do if I think I’ve caught the virus?

If you have travelled through an affected area or been in contact with someone who might be infected, and you become unwell, isolate yourself immediately and seek medical advice.

Phone ahead to your GP clinic or nearest Emergency Department.  Do not simply turn up.  Advise the receptionist that you may have COVID-19.  The practice will instruct you on what to do next, according to local health service plans and government advice.

If you have serious symptoms, for example if it is hard to breathe, call 000 for an ambulance.  Advise the operator that you may have been exposed to the coronavirus.

What if I’ve been exposed and I go into labour?

Both North Shore Private Hospital and The Mater Hospital are prepared for patients with COVID-19.  Obstetric patients will still be looked after in the maternity unit of their booked hospital.  It is ESSENTIAL to phone the Delivery Suite of your booked hospital before you attend.  This will allow the maternity staff to prepare for your arrival and meet you with appropriate infection-control measures in place.

Be aware that both hospitals have introduced visitor restrictions for the delivery suite, maternity wards and nursery.  While we appreciate this will be disappointing for some, please understand that it is designed to protect pregnant women, their babies and hospital staff.  Protecting vulnerable groups by limiting potential exposure is a key strategy in fighting any disease outbreak.

Where can I get updates and further information?