This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the evidence related to vertical transmission of 2019-nCoV during pregnancy
2. Describe maternal and fetal risks that were reported during previous outbreaks of atypical viral pneumonias
Estimated time to complete activity: 0.5 hours
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 02-28-2020 through 02-28-2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.5 contact hours.Read Disclaimer & Fine Print
NOTE: CDC has updated guidance that clearly recommends COVID-19 vaccination in pregnancy. Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date.
The spread of COVID-19 is being closely monitored worldwide. The following provides key highlights from major professional organizations along with valuable links to other resource hubs focused on COVID-19 and pregnancy
Although these data from the CDC suggest an increase in risk of severe outcomes in pregnant women with symptomatic SARS-CoV-2 infection, the absolute risk is still substantially lower than that of pandemic H1N1 influenza infection during pregnancy. During the H1N1 influenza pandemic, pregnant women made up 5% of deaths, despite only making up 1% of the population and pregnancy risk of ICU admission was reported as high as a 7-fold increase
The following is a summary of precautions related to pregnant women with suspected or confirmed COVID-19 | The full CDC recommendations can be found at the CDC: Considerations for Inpatient Obstetric Healthcare Settings page (find link below in ‘Learn More – Primary Sources’)
Mother-Infant Separation: Vertical Transmission and Newborn Risk
Separation in order to reduce the risk of transmission from a mother with suspected or confirmed SARS-CoV-2 to her neonate may not be necessary
Infection Controls if No Separation
Breastfeeding when Mother has Suspected or Confirmed COVID-19
Note: CDC defines hand hygiene as follows
Hand hygiene includes use of alcohol-based hand sanitizer that contains 60% to 95% alcohol before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Hand hygiene can also be performed by washing with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to alcohol-based hand sanitizer.
Severe illness includes illness that results in intensive care admission, mechanical ventilation, or death
Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19
ACOG recommends that all eligible persons, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series
Obstetrician-gynecologists and other women’s health care practitioners should lead by example by being vaccinated and encouraging eligible patients to be vaccinated as well
…recommends that pregnant, postpartum, and lactating people and those
considering pregnancy receive the COVID-19 vaccination
Vaccination is the best method to reduce maternal and fetal complications of SARS-CoV-2 infection
Counseling to support the recommendation for vaccination should include available data
on vaccine efficacy, as well as data on vaccine safety during pregnancy and lactation.
Provider counseling has been shown to have a significant positive impact on patient
Available data indicate that COVID-19 vaccines do not cause infertility in women or men
In the randomized blinded Pfizer-BioNTech trial, a similar number of women conceived after receiving the vaccine as those who received the placebo
UK Joint Committee on Vaccination and Immunisation (JCVI)
…all individuals who are pregnant or those trying to become pregnant should receive the COVID-19 vaccination
…there is no evidence to suggest that COVID-19 vaccines will affect fertility
This decision should be based on the woman’s personal values and an understanding that the risks of COVID-19 outweigh the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding
WHO recommends the use of the COVID-19 vaccine in pregnant women when the benefits of vaccination to the pregnant woman outweigh the potential risks
To help pregnant women make this assessment, they should be provided with information about the risks of COVID-19 in pregnancy, the likely benefits of vaccination in the local epidemiological context, and the current limitations of safety data in pregnant women
WHO does not recommend pregnancy testing prior to vaccination
WHO does not recommend delaying pregnancy or terminating pregnancy because of vaccination
Forceful exhalation during the second stage of labor is not considered an aerosol-generating procedure for respirator prioritization during shortages over procedures more likely to generate higher concentrations of infectious respiratory aerosols
When respirator supplies are restored, as with all clinical care activities for patients with known or suspected COVID-19, HCP should use respirators (or facemasks if a respirator is not available), eye protection, gloves, and gowns during the second stage of labor, in addition to other personal protective equipment that may be typically indicated for labor and delivery
Tap Image to Open Algorithm
Fetal Surveillance and Management
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 midtrimester anatomy ultrasound examination may be considered following first-trimester maternal infection.
For those experiencing illness later in pregnancy, it is reasonable to consider sonographic assessment of fetal growth in the third trimester
Delivery Planning for Mildly Symptomatic or Asymptomatic Pregnant Patients
Delivery for Patients Who are Critically Ill
Although data regarding delivery timing and acute respiratory distress syndrome are limited, it is reasonable to consider delivery in the setting of worsening critical illness
COVID-19 Screening and Donor Programs
Providers should proactively and deliberately encourage patients to ask questions regarding COVID-19 and the pandemic throughout their treatment and may wish to counsel patients on reliable sources of information
Effect on Pregnant Women
Effects on Fetus and Neonate
Pregnant Healthcare Workers
Choices for pregnant healthcare workers prior to 28 weeks’ gestation: Following a risk assessment with their employer and occupational health, pregnant women should only be supported to continue working if the risk assessment advises that it is safe for them to do so. This means that employers must remove any risks (that are greater in the workplace than to what they would be exposed to outside of the workplace), or else they should be offered suitable alternative work
For pregnant women from 28 weeks’ gestation, or with underlying health conditions such as heart or lung disease at any gestation, a more precautionary approach is advised. Women in this category should be recommended to stay at home. For many healthcare workers, this may present opportunities to work flexibly from home in a different capacity, for example by undertaking telephone or videoconference consultations, or taking on administrative duties
Note: Find additional international professional guidelines below in ‘Learn More – Primary Sources’
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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