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At this time very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19.

As ACOG members continue providing patient care during this time, we understand that both they and their patients have questions about women's health during the pandemic. These FAQs are developed by several Task Forces, assembled of practicing obstetrician-gynecologists and ACOG members with expertise in obstetrics, maternal-fetal medicine, gynecology, gynecologic subspecialties, pediatric and adolescent gynecology, infectious disease, hospital systems, telehealth, and ethics, who are on the frontline caring for patients during this pandemic.

These FAQs are based on expert opinion and are intended to supplement the Centers for Disease Control and Prevention (CDC) guidance and the American College of Obstetricians and Gynecologists (ACOG) Practice Advisory with information on how to optimize obstetric care in the context of COVID-19. The COVID-19 pandemic is a rapidly evolving situation and ACOG encourages local facilities and systems, with input from their obstetric care professionals, to develop innovative protocols that meet the health care needs of their patients while considering CDC guidance, guidance from local and state health departments, community spread, health care personnel availability, geography, access to readily available local resources, and coordination with other centers.

This is a rapidly changing landscape, and FAQs will be added or modified on a regular basis as the pandemic evolves and additional information becomes available.

Patients: Please refer to this page for information on coronavirus, pregnancy, and breastfeeding.

 

 Staffing, Personnel, and Hospital Resources

  • Q: Should pregnant health care personnel be transferred to roles where they are not providing in-person patient care to help reduce their risk?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Based on limited data regarding COVID-19 and pregnancy, ACOG currently does not propose creating additional restrictions on pregnant health care personnel because of COVID-19 alone. Pregnant women do not appear to be at higher risk of severe disease related to COVID-19. Pregnant health care personnel should follow CDC risk assessment and infection control guidelines for health care personnel exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all health care personnel in health care settings.

    Information on COVID-19 in pregnancy is very limited; however, facilities may want to consider limiting exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher-risk procedures (eg, aerosol-generating procedures), if feasible, based on staffing availability.

  • Q: What personal protective equipment (PPE) should clinicians and patients wear for potential or confirmed COVID-19 patients?

    Last updated March 26, 2020 at 7:20 p.m. EST

    COVID-19 infection is highly contagious, and this must be taken into consideration when planning intrapartum care. All medical staff caring for potential or confirmed COVID-19 patients should use personal protective equipment (PPE) listed below, including respirators (eg. N95 respirators) when available. Importantly, all medical staff should be trained in and adhere to proper donning and doffing of PPE. Personal protective equipment recommended by the Centers for Disease Control and Prevention (CDC) is listed below, and CDC provides strategies for how to optimize the supply of PPE. ACOG  and SMFM have also made statements regarding the urgent need for PPE in obstetrics. 

    CDC Recommended Personal Protective Equipment:

    • Respirator or Facemask
      • Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.
      • N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure. Disposable respirators and facemasks should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator or facemask. 
        • If reusable respirators (eg, powered air purifying respirators [PAPRs]) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions before re-use.
      • When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19.
    • Eye Protection
      • Put on eye protection (ie, goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.
      • Remove eye protection before leaving the patient room or care area.
      • Reusable eye protection (eg, goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions before re-use.
      • Disposable eye protection should be discarded after use.
    • Gloves
      • Put on clean, nonsterile gloves upon entry into the patient room or care area.
        • Change gloves if they become torn or heavily contaminated.
      • Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.
    • Gown
      • Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.
      • If there are shortages of gowns, they should be prioritized for:
        •  Aerosol-generating procedures
        • Care activities where splashes and sprays are anticipated
        • High-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of health care practitioner. Examples include: 
          • Dressing
          • Bathing/showering
          • Transferring
          • Providing hygiene
          • Changing linens
          • Changing briefs or assisting with toileting
          • Device care or use
          • Wound care

    During N95 respirator shortages, facilities might need to prioritize N95 respirator use for aerosol-generating procedures and use facemasks for other types of care.  Even in a shortage, it is important that medical staff use appropriate forms of PPE, including surgical mask. During shortages, facilities are encouraged to take steps that facilitate the protection of medical staff and enable personnel to protect themselves.

    Patients:
    Although a person with suspected or confirmed COVID-19 would normally be instructed to wear a mask, active pushing while wearing a surgical mask may be difficult and forceful exhalation may significantly reduce the effectiveness of a mask in preventing the spread of the virus by respiratory droplets.

     
  • Q: How can facilities prepare obstetric care clinicians to respond to COVID-19?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Hospitals that provide maternity services should create, or—if already established—mobilize their perinatal subcommittee in charge of disaster preparedness (likely to include representatives from obstetric, pediatric, family medicine, and anesthesia teams among others) (Committee Opinion 726).

    In some areas with high prevalence and community spread, a shortage of obstetric health care personnel may occur. Regardless of whether an area is currently experiencing wide community spread, ACOG encourages all facilities to begin strategizing how to expand their obstetric work force. Facilities should consider rapid credentialing and privileging of temporary obstetric care clinicians not currently practicing obstetrics to enable augmentation of the work force (Committee Opinion 726), retraining these individuals as necessary, and ensuring proper insurance coverage.

    Additionally, if not already doing so, facilities are encouraged to find innovative ways to collaborate with family physicians, midwives who are certified by the American Midwifery Certification Board (or its predecessor organizations) or whose education and licensure meet the International Confederation of Midwives Global Standards for Midwifery Education, and other obstetric care professionals.

  • Q: How can elective procedures be managed to optimize personnel and resources?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    In areas where COVID-19 is particularly prevalent or where there is particular stress on the health care system, it may be advantageous to identify and modify surgical scheduling, including for procedures that are medically indicated, when a patient’s health and safety would not be harmed by such delay.

    For obstetrics, it may be appropriate to temporarily consider tubal sterilization only when performing cesarean birth (unless the patient is considered high risk) and all others as elective, so long as an alternative form of contraception is provided (eg, immediate postpartum long-acting reversible contraception), if desired by the patient. However, any decision regarding which procedures to consider elective should be made on a local and regional level, considering the risks and resources specific to each area. Obstetric and gynecologic procedures for which a delay will negatively affect patient health and safety should not be delayed. This includes gynecologic procedures and procedures related to pregnancy for which delay would harm patient health.

    See ACOG’s Joint Statement on Elective Surgery for additional information.

  • Q: What is the best approach to cleaning surfaces?

    Last updated March 26, 2020 at 8:00 a.m. EST.

    Clinicians should follow CDC guidance in regards to properly cleaning surfaces.

General Considerations

  • Q: Does COVID-19 present an increased risk of severe morbidity and mortality for pregnant women compared with nonpregnant women? NEW

    Last updated April 3, 2020 at 3:00 p.m. EST.

    Historically, respiratory infections in pregnant women have been thought to increase their risk for severe morbidity and mortality. With regard to COVID-19, the limited data currently available do not indicate that pregnant individuals are at an increased risk of infection or severe morbidity (eg, need for ICU admission or mortality) compared with nonpregnant individuals in the general population. Pregnant patients with comorbidities may be at increased risk for severe illness consistent with the general population with similar comorbidities. To date, consistent with our experience with other respiratory viruses such as MERS, SARS, and influenza, there is no conclusive evidence of vertical transmission of COVID-19. ACOG will continue to diligently monitor the literature for any COVID-19 risk signals in pregnancy.

    All individuals, including pregnant individuals, are encouraged to take precautions to avoid exposure to COVID-19 as the situation evolves. We understand that our patients are experiencing increased stress and anxiety due to COVID-19. When counseling pregnant patients about COVID-19, it is important to acknowledge that these are unsettling times. Clinicians are encouraged to share ACOG’s patient resources as appropriate.

    ACOG is working to address the concerns that have been raised about the effect of COVID-19 in pregnant individuals and encourages all of our members and any clinician who cares for pregnant patients with known or suspected COVID-19 to submit information to the PRIORITY registry.

  • Q: How should visitation rules be modified in the setting of the COVID-19 pandemic?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Modifications to visitation policies should be made on an individual facility level based on community spread and local and state recommendations. In both the inpatient and outpatient setting, it is recommended that the number of visitors be reduced to the minimum necessary. The CDC provides suggested guidance for managing visitors in inpatient obstetric health care settings.

  • Q: Should pregnant patients wear a mask?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Pregnant patients should follow the same recommendations as the general population with regard to wearing a mask. Masks should only be worn by those experiencing symptoms of COVID-19 or those with confirmed COVID-19 when they are in public or around other individuals.

Prenatal Care

  • Q: How can obstetrician–gynecologists guide pregnant patients regarding the safety of working in the non-health care environment? NEW

    Last update April 3, 2020 at 3:00 p.m. EST.

    ACOG understands that health care professionals are being asked about unique requests for work accommodations specific to COVID-19. We recommend that employers follow current CDC guidance and direction from local and state health departments, which may include advice on how to increase social distancing (such as remote working when possible). Many locations in the United States are now under stay-at-home orders or have ordered nonessential businesses to close. All individuals, including pregnant individuals, are encouraged to take precautions to avoid exposure to COVID-19. 

    If a pregnant individual is still working, it is important to understand the request in context of the risk to the pregnant individual. Historically, respiratory infections in pregnant patients have been thought to increase their risk of severe morbidity and mortality. However, the limited data available on COVID-19 does not indicate that pregnant individuals are at increased risk of infection or severe morbidity (eg, need for ICU admission or mortality) compared with nonpregnant individuals in the general population. Adaptations made for the general population also should be applied to pregnant patients. Pregnant patients with comorbidities may be at increased risk of severe illness, consistent with the general population with similar comorbidities, and may therefore need similar adaptations to reduce exposure. We will continue to diligently monitor the literature for any COVID-19 risk signals in pregnancy.

    Requests for leave will depend on the patient’s comorbidities and the individual work situation (see Committee Opinion 733, Employment Considerations During Pregnancy and the Postpartum Period, for more information on writing a work accommodation note and key resources to provide patients).

    We understand that our patients are experiencing increased stress and anxiety because of COVID-19. When counseling pregnant patients about COVID-19, it is important to acknowledge that these are unsettling times. Health care professionals are encouraged to share ACOG’s patient resources as appropriate. ACOG will continue to diligently monitor the literature for any COVID-19 risk signals in pregnancy.

  • Q: Is it appropriate to modify prenatal care delivery to decrease the risk of COVID-19 spread and exposure?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes. Alternate prenatal care delivery approaches have been proposed as a strategy in the effort to control the spread of COVID-19 among patients, caregivers, and staff. Although evidence is limited regarding the safety and efficacy of these approaches, ACOG recognizes the need to implement innovative strategies during this rapidly evolving public health emergency, with consideration of differences in care settings and population risks. Any decision to modify prenatal care delivery should be made at the local and individual level.

    • Obstetrician–gynecologists and other obstetric care clinicians should continue to provide medically necessary prenatal care, referrals, and consultations.
    • Obstetric care clinicians should be prepared to explain the rationale for any change in prenatal care or delivery scheduling, emphasizing that these modifications have been made in order to limit the risk of exposure to the virus for the mother and the fetus or infant.
    • It is recommended that the patient–physician discussion regarding a plan for alternate prenatal care in the setting of the COVID-19 pandemic be documented in the medical record.

    Some examples of approaches to modifying prenatal care that may be considered are listed below. However, modifying or reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal care approaches and schedules should resume when this risk subsides. Plans for modified care are best made at the local level with consideration of patient populations and available resources.

    • Spacing out appointments.
      • Health care clinicians may choose to continue in-person prenatal care appointments for patients who are not sick, if staffing is available, but space out in-person appointment times where appropriate to reduce the number of patients in the office or facility at one time.
      • This may be accompanied by postponing some nonemergent gynecologic or well-woman appointments to facilitate social distancing and to maintain availability to accommodate medically necessary appointments; appointments for which a delay will negatively affect patient health and safety should not be delayed.

    • Alternate or reduced prenatal care schedules.
      • Consider grouping components of care together (eg, vaccinations, glucose screenings, etc) (Committee Opinion 718) to reduce the number of in-person visits.
      • Examples of alternate or reduced prenatal care schedules are listed below as resources. These examples are shared with the express permission of their developers, and without identification when requested. These examples, along with relevant journal publications listed below, are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists.
  • Q: Can telehealth strategies help assist obstetric care delivery?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes, and ACOG encourages practices and facilities that do not yet have the infrastructure to offer telehealth to begin strategizing how telehealth could be integrated into their services as appropriate. Importantly, the ability to access telemedicine may vary by patient resources and some assessment of this—although often challenging in times of crisis—will be necessary to ensure equitable care.

    As part of the COVID-19 emergency response, several new federal telehealth allowances have been made. These may be subject to ongoing changes; please see ACOG’s Managing Patients Remotely: Billing for Digital and Telehealth Services for the latest information on federal policy changes and coding advice.

    The Department of Health and Human Services Office for Civil Rights has announced that it will exercise enforcement discretion and waive penalties for HIPAA violations against health care clinicians who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency. See HHS.gov for more information on the Department of Health and Human Services response to COVID-19 and HIPAA.

    The Drug Enforcement Administration has released guidance allowing health care clinicians registered by the administration to issue prescriptions for controlled substances without an in-person medical evaluation for the duration of the public health emergency (see specific guidelines here).

  • Q: Should I screen patients before they come in for in-person appointments?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Health care clinicians can also consider an approach (eg. phone, telehealth) to implement routine screening of patients, and their guests if permitted, for potential exposure or COVID-19 symptoms (cough, sore throat, fever) before their in-person appointment to prevent any potential persons under investigation from entering the facility. Patients should be instructed to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (eg, cough, sore throat, fever) on the day they are scheduled to be seen. This can be done through phone calls before appointments asking about recent travel, potential exposure, and symptoms. Proactive communication to all patients (ie, via email, text, recorded phone calls) advising individuals with possible exposure to or symptoms of COVID-19 to call the office first also may be considered. Additionally, health care clinicians should confirm whether a person is currently undergoing testing for COVID-19.

    If, after screening, the patient reports symptoms of or exposure to a person with COVID-19, that patient should be instructed not to come to the health care facility for their appointment and health care clinicians should contact the local or state health department to report the patient as a possible person under investigation (PUI).

  • Q: Which antenatal fetal surveillance and ultrasound examinations are essential to continue as recommended?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Antenatal fetal surveillance and ultrasonography (Practice Bulletin 175) should continue as medically indicated when possible. Elective ultrasound examinations should not be performed (Practice Bulletin 175), and ultrasonography should be used prudently and only when its use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient (Committee Opinion 723).

    It may be appropriate to postpone or cancel some testing or examinations if the risk of exposure and infection within the community outweighs the benefit of testing. However, this should be a decision made at the local practice or facility level, balancing the risks and benefits of decreased exposure, completing the test, and site capacity. As with other components of prenatal care, reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal antenatal testing or ultrasonography scheduling should resume when this risk subsides.

    Any modifications made to care should be relayed to patients with a discussion of the altered balance of risks and -benefits of coming to the office for testing or ultrasonography in the setting of a global pandemic, and should be documented in the medical record.

  • Q: Do patients with suspected or confirmed COVID-19 need additional antenatal fetal surveillance?

    Last updated March 26, 2020 at 8:00 a.m. EST.

    During acute illness, fetal management should be similar to that provided to any ill pregnant person. 

    Very little is known about the natural history of pregnancy after a patient recovers from COVID-19. In the setting of a mild infection, management similar to that for a patient recovering from influenza is reasonable. Given how little is known about this infection, a detailed mid-trimester anatomy ultrasound examination may be considered following first-trimester maternal infection  (SMFM Coronavirus COVID-19 and Pregnancy). For those experiencing illness later in pregnancy, it is reasonable to consider sonographic assessment of fetal growth in the third trimester (SMFM Coronavirus COVID-19 and Pregnancy).

  • Q: Are there any special considerations regarding use of low-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy or the postpartum period in a patient with suspected or confirmed COVID-19?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    ACOG is aware of news reports suggesting that the use of nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, could worsen COVID-19. ACOG also is aware of the Lancet article hypothesizing that NSAIDs (ibuprofen in particular) could aggravate COVID-19 symptoms, although pregnancy was not specifically addressed in this article.

    Currently, ACOG is not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms. As such, and because of the prevalence of low-dose aspirin use during pregnancy and the importance of low-dose aspirin in preeclampsia prevention (Committee Opinion 743, Practice Bulletin 202), low-dose aspirin should continue to be offered to pregnant and postpartum women as medically indicated. For patients with suspected or confirmed COVID-19 for whom low-dose aspirin would be indicated, modifications to care may be individualized.

    ACOG continues to monitor the situation and the FDA continues to investigate the issue.

  • Q: Are there special considerations regarding recommended use of antenatal corticosteroids for a patient with suspected or confirmed COVID-19?

    Last updated March 26, 2020 at 8:00 a.m. EST.

    For the general population, the CDC recommends that corticosteroids should be avoided because of the potential for prolonging viral replication as observed in MERS-CoV patients, unless indicated for other reasons (CDC). However, for pregnant patients, ACOG is not aware of scientific evidence specific to the use of antenatal corticoid steroid use for fetal maturation in a pregnant patient with suspected or confirmed COVID-19.

    As such, ACOG suggests the following modifications during the COVID-19 pandemic:

    • Before 34 0/7 Weeks of Gestation

      Because of the well-established benefit of antenatal corticosteroid administration with decreased neonatal morbidity and mortality, antenatal corticosteroids should continue to be offered as recommended (Committee Opinion 713, Practice Bulletin 171) for pregnant patients with suspected or confirmed COVID-19 who are between 24 0/7 weeks and 33 6/7 weeks of gestation and at risk of preterm birth within 7 days. Modifications to care for these patients may be individualized, weighing the neonatal benefits of antenatal corticosteroids with the risks of potential harm to the pregnant patient.

    • 34 07/–36 6/7 Weeks of Gestation (Late Preterm)

      The benefits of antenatal corticosteroids in the late preterm period are less well-established (Committee Opinion 713, Practice Bulletin 171). As such, and weighing this against any potential harm to the pregnant patient, antenatal corticosteroids should not be offered to pregnant patients with suspected or confirmed COVID-19 who are between 34 0/7 weeks and 36 6/7 weeks of gestation and at risk of preterm birth within 7 days. Modifications to care for these patients may be individualized, weighing the neonatal benefits of antenatal corticosteroids with the risks of potential harm to the pregnant patient.

    In the setting of critical maternal illness, the risk and benefits should be considered at any gestational age prior to administration but is not routinely recommended in the late preterm period (Practice Bulletin 211). Indicated delivery should not be delayed for administration of steroids in the late preterm period (Practice Bulletin 211, Committee Opinion 713, Practice Bulletin 171)


  • Q: Are there any special considerations regarding GBS collection?

    Last updated March 26, 2020 at 8:00 a.m. EST.

    Group B streptococcus (GBS) screening should occur as indicated during the recommended time period, 36 0/7–37 6/7 weeks of gestation (Committee Opinion 797). Consideration may be given to grouping other components of care during the GBS screen at 36 0/7–37 6/7-week window to reduce the number of in-person prenatal visits needed. Alternatively, patients can self-collect with proper instruction on how to collect a vaginal-rectal swab if the resources and infrastructure are in place to do so.

  • Q: How should I counsel patients who are considering home birth because of concerns about COVID-19?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Although recognizing that many patients are experiencing new concerns because of the COVID-19 pandemic, ACOG continues to recommend following existing evidence-based guidance regarding home birth. Please see Committee Opinion 697Planned Home Birth, for additional guidance, including counseling regarding risk and benefits and absolute contraindications.

  • Q: Are there additional components to prenatal care that should be considered?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes. It may be necessary to:

    • Offer mental health or social work services or referrals to provide additional resources, particularly for patients who are experiencing anxiety regarding the COVID-19 pandemic or are at an increased risk of intimate partner violence (Committee Opinion 518).
    • Provide enhanced anticipatory counseling to patients regarding:
      • Any potential changes to length of hospital stay and postpartum care.
      • How to best communicate with their obstetric care team, especially in the case of an emergency.
      • Signs and symptoms of labor and when to call their obstetric care clinician.
      • Any special considerations for infant feeding.
      • Checking with their pediatric clinician or family physician regarding newborn visits because pediatric clinicians or family physicians also may be altering their procedures and routine appointments (American Academy of Pediatrics).
      • Postpartum contraception. Ideally, all methods of contraception should be discussed in context of how provision of contraception may change within the limitations of decreased postpartum in-person visits. For patients who express interest in postpartum contraception, clinicians should discuss the additional benefit of immediate postpartum long-acting reversible contraception (LARC): an additional visit for placement is not needed (Committee Opinion 670) and placement is not resource intensive. (For information on tubal sterilization, please see How can elective procedures be managed to optimize personnel and resources?)
      • Any potential changes to their postpartum care team and support system. Most patients will likely have had changes to expected care support resources at home (eg, family who can no longer travel, childcare providers who are no longer available). To the extent possible, patients should be connected to community support resources.

    It should be noted that it may be necessary to provide these services or other enhanced resources by phone or electronically where possible. If telehealth visits are anticipated, patients should be provided with any necessary equipment (eg, blood pressure cuffs) if available and as appropriate.

     

Intrapartum Care

When a pregnant patient with suspected or confirmed COVID-19 is admitted and birth is anticipated, the obstetric, pediatric or family medicine, and anesthesia teams should be notified in order to facilitate care.

  • Q: Is timing of delivery affected by COVID-19?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Timing of delivery, in most cases, should not be dictated by maternal COVID-19 infection. For women with suspected or confirmed COVID-19 early in pregnancy who recover, no alteration to the usual timing of delivery is indicated. For women with suspected or confirmed COVID-19 in the third trimester who recover, it is reasonable to attempt to postpone delivery (if no other medical indications arise) until a negative testing result is obtained or quarantine status is lifted in an attempt to avoid transmission to the neonate. In general, COVID-19 infection itself is not an indication for delivery.

  • Q: Is COVID-19 considered an indication for cesarean delivery for patients with suspected or confirmed COVID-19 infection?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    No. Currently, based on very limited data based on primarily cesarean deliveries, there does not appear to be a risk of vertical transmission via the transplacental route. Additionally, based on limited data, outcomes for individuals appear to be similar between pregnant and nonpregnant patients. Cesarean delivery should therefore be based on obstetric (fetal or maternal) indications and not COVID-19 status alone.

    In the event that an individual should request a cesarean delivery because of COVID-19 concerns, obstetrician–gynecologists and other obstetric care clinicians should follow ACOG’s guidance provided in Committee Opinion 761Cesarean Delivery on Maternal Request.

  • Q: How can scheduled inductions of labor or cesarean deliveries be managed to optimize personnel and resources?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Inductions of labor and cesarean deliveries should continue to be performed as indicated. Decisions on how to schedule these procedures in the time of the COVID-19 pandemic are best made at the local facility and systems level, with input from obstetric care professionals and based on health care personnel availability, geography, access to readily available local resources, and coordination with other centers. (For information on elective procedures, please see How can elective procedures be managed to optimize personnel and resources?)

  • Q: Is operative vaginal delivery indicated in a patient with suspected or confirmed COVID-19?

    Last update March 26, 2020 at 8:00 a.m. EST.

    No, operative vaginal delivery is not indicated for suspected or confirmed COVID-19 alone. Practitioners should follow usual clinical indications for operative vaginal delivery, in the setting of appropriate personal protective equipment (Practice Bulletin 154 on Operative Vaginal Delivery).

     

  • Q: Is delayed cord clamping still appropriate in a patient who has suspected or confirmed COVID-19?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes, delayed cord clamping is still appropriate in the setting of appropriate clinician personal protective equipment. Although some experts have recommended against delayed cord clamping, the evidence is based on opinion; a single report later confirmed COVID-19 transmission most likely occurred from the obstetric care clinician to the neonate. Current evidence-based guidelines for delayed cord clamping should continue to be followed until emerging evidence suggests a change in practice. See Committee Opinion 684, Delayed Umbilical Clamping After Birth, for more information.

  • Q: How should umbilical cord blood banking be managed during the COVID-19 pandemic?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Respiratory diseases are typically not transmitted by the transfer of human cells. Currently, there are no reported cases of transmission of COVID-19 by blood products (FDA); therefore, umbilical cord blood banking can continue to be managed according to clinical guidance (Committee Opinion 771), in the setting of appropriate clinician personal protective equipment. A variety of circumstances may arise during the process of labor and delivery that may preclude adequate cord blood collection. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation (Committee Opinion 771).

  • Q: How can doulas support maternal care and delivery during the COVID-19 pandemic?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    The question of the presence of doulas should be answered in the context of the institutional visitor policy. If doulas are considered by the facility to be health care personnel, they need to be able to adhere to the infection prevention and control recommendations, including the correct and consistent use of proper personal protective equipment. If they are not designated as health care personnel by the facility, they would be considered to be visitors and included in that facility’s visitor count.

Postpartum Care

  • Q: Should expedited discharge be considered during the COVID-19 pandemic?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes. To limit the risk of inadvertent exposure and infection, it may be appropriate to expedite discharge when both the mother and the infant are healthy (Committee Opinion 726). For example, discharge may be considered after 1 day for women with uncomplicated vaginal births and after 2 days for women with cesarean births depending on their status. Early discharge will require discussion with the facility’s pediatric care team and should be linked to home telehealth visits for the mother and infant.

  • Q: Are there additional components to postpartum care that should be considered?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    Yes. It may be necessary to:

    • Offer mental health or social work services or referrals to provide additional resources, particularly for patients who are experiencing anxiety regarding the COVID-19 pandemic or are at an increased risk of intimate partner violence (Committee Opinion 518).
    • Offer modified postpartum counseling regarding:
      • Any potential changes to the length of hospital stay and postpartum care.
      • How to best communicate with their postpartum care team, especially in the case of an emergency.
      • When and how to contact their postpartum care clinician.
      • Any special considerations for infant feeding.
      • Checking with their pediatric clinician or family physician regarding newborn visits because pediatric clinicians or family physicians also may be altering their procedures and routine appointments (American Academy of Pediatrics).
      • Postpartum contraception. Ideally, all methods of contraception should be discussed in context of how provision of contraception may change within the limitations of decreased postpartum in-person visits.
      • Any potential changes to their postpartum care team and support system. Most patients will likely have had changes to expected care support resources at home (eg, family who can no longer travel, childcare providers who are no longer available). To the extent possible, patients should be connected to community support resources.

    It should be noted that it may be necessary to provide these services or enhanced resources by phone or electronically where possible. If telehealth visits are anticipated, patients should be provided with any necessary equipment (eg, blood pressure cuffs) if available and as appropriate.


  • Q: Is it appropriate to modify postpartum care delivery approaches to decrease the risk of COVID-19 exposure?

    Last updated March 23, 2020 at 11:30 p.m. EST.

    As with prenatal care, yes (see Is it appropriate to modify prenatal care delivery to decrease the risk of COVID-19 spread and exposure? for important considerations). However, modifying or reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal care approaches and schedules should resume when this risk subsides. Plans for modified care are best made at the local level with consideration of patient populations and available resources. Some examples of approaches to modifying postpartum care that may be considered are listed below.

    • Perform the initial three week (or sooner) assessment (Committee Opinion 736), wound checks, and blood pressure checks by phone or telehealth visits, if possible.
    • Delay the comprehensive postpartum visit to 12 weeks, with the intention of seeing the patient for the comprehensive assessment in person and using telehealth visits as needed before 12 weeks. However, it should be noted that some patients may lose insurance before 12 weeks postpartum; in this case, the comprehensive postpartum visit should be prioritized and scheduled before the patient loses insurance and also can be completed by telehealth visit.

If you have unanswered COVID-19 questions or comments, please send them to covid@acog.org.


This document has been developed to respond to some of the questions facing clinicians providing care during the rapidly evolving COVID-19 situation. As the situation evolves, this document may be updated or supplemented to incorporate new data and relevant information. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on acog.org or by calling the ACOG Resource Center.

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