Safe delivery for pregnancies affected by COVID‐19

Abstract

Since December 2019, a new coronavirus infection (COVID-19) has rapidly become prevalent in central China.1 On the basis of knowledge obtained from a previous coronavirus outbreak,2 pregnant women are believed to be susceptible to this virus. Once a maternal infection of COVID-19 is suspected or confirmed, childbirth becomes complicated and challenging. Efficient obstetric treatment is required and is key to optimising the prognosis for both mother and child. Care should be taken with determining the timing of the delivery, the assessment of the indications for caesarean section, the preparation of the delivery room to prevent infection, the choice of the type of anaesthesia and the management of the newborn. According to expert advice on novel coronavirus infection in pregnancy and the puerperium,1, 3 issued by the Chinese Medical Association (CMA), the current consensus is that COVID-19 infection is not an absolute indication for delivering a baby early, but that expedited delivery should be evaluated on a case-by-case basis. Maternal disease progression, gestational age and fetal intrauterine status are the primary concerns. If maternal safety is assured, the timing of delivery should be determined primarily by gestational age. In summary, the current opinion of obstetric experts is that the timing of delivery should be determined by maternal disease status. Maternal safety is the priority; multidisciplinary consultation and the opinions of critical care medical experts should be considered carefully. These suggestions are aimed at reducing maternal inpatient stays, minimising the chance of cross-infection, reducing maternal physical exertion during delivery and ensuring the safety of other postnatal women, newborns and healthcare workers. There are currently very few pregnant women infected with COVID-19; thus, a lowered threshold for caesarean section will not significantly increase the overall caesarean section rate. Epidural anaesthesia or general anaesthesia can be used for delivery in pregnant women suffering with pneumonia as a result of COVID-19 infection;3, 9 for pregnant women infected with COVID-19 who are already intubated, general anaesthesia through endotracheal intubation can be used during caesarean section. Most practitioners advocate the use of epidural anaesthesia for pregnant women infected with pneumonia of COVID-19 to reduce any exacerbation of the infection during the intubation/extraction process, and to avoid the side effects of general anaesthesia on newborns (i.e. muscle tone and breathing). Importantly, anaesthesiologists must apply airborne precautions to prevent infection while performing trachea intubation. None declared. Completed disclosure of interests forms are available to view online as supporting information. HQ, XL, YZ, HZ, JL, LZ, LF, DC, YS, CT and PB conceived this study, HQ, XL, YZ, CT and PB wrote the draft, and HZ, JL, LZ, LF, DC and YS revised the article. Not required. None. None. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.