Experience of Clinical Management for Pregnant Women and Newborns with Novel Coronavirus Pneumonia in Tongji Hospital, China

Abstract

Based on the New Diagnosis and Treatment Scheme for Novel Coronavirus Infected Pneumonia (Trial Edition 5), combined with our current clinical treatment experience, we recently proposed a revision of the first edition of "Guidance for maternal and fetal management during pneumonia epidemics of novel coronavirus infection in the Wuhan Tongji Hospital". This article focused on the issues of greatest concern of pregnant women including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnostic criteria, inspection precautions, drug treatment options, indications and methods of termination of pregnancy, postpartum fever, breastfeeding considerations, mode of mother-to-child transmission, neonatal isolation and advice on neonatal nursing, to provide valuable experience for better management of SARS-CoV-2 infection in pregnant women and newborns.

Pregnancy during the evolving pandemic Coronavirus Disease 2019 (COVID-19): A rapid scoping review of early evidence in the published literature

“…16 studies presented clinical findings of COVID-19 among pregnant women, which includes six original articles [12,13,[20][21][22]38], three case reports [15,32,33], two case-reviews [29,36], two research letters [18,37], and one correspondence [34], rapid review [24] and systematic review and meta-analysis [14] each. Out of these 16 studies, only 13 reported original data [12,13,15,18,[20][21][22]24,[32][33][34]37,38] and three study [14,29,31] reviewed data from existing studies ( Table 3). Cumulatively clinical features of 229 pregnant women were reported in this review -ranging from a single [18,[32][33][34]37] to 41 pregnant women [14,21].…”

“…Twelve studies exclusively discussed management recommendations. Among these studies, three were correspondences [16,23,31], two were commentaries [26,27], two were opinion pieces [25,35], one of case review [36], expert consensus [11], expert review [28], review article [5], and special editorial [19] each (Table 4). • The pregnant women were discharged after her nasopharyngeal swabs were negative for SARS-CoV-2 and clinical condition was improved Yu et al [36] Original article Seven pregnant women with COVID-19 between 37 weeks to 41 weeks of the gestational period…”

“…• The screening process should begin before the pregnant woman arrives in the facility. If possible, detailed of clinical features and respiratory signs and symptoms should be discussed and noted over the telephone or using any online portal [28,31] • Immediate isolation of the suspected pregnant women in a single room for screening [11,19,[25][26][27][28]31,38] • Travel history, contact history, and patient's location in a known clustering occurrence need to be investigated during the initial assessment [11,25,28,31,38] • Movement of the suspected pregnant women should be restricted throughout the facility [11,27,28] Diagnostic procedures…”

“…• For diagnostic confirmation repeated testing may be required [11,16,19,20,25,28,31] • X-ray and computed tomography (CT) with abdominal shielding can be performed.…”

“…• May cause radiation exposure to the fetus [5,11,19,24,25,31] • Imaging is particularly important as a pregnant woman with imaging characteristics of COVID-19 should be considered as a clinically diagnosed case even if laboratory confirmation of SARS-CoV-2 is negative [31] • One study recommended application of lung ultrasound to identify pathological lesion indicative of COVID-19 [23] • The blood sample should be collected for microbial cultures to investigate any secondary bacterial infection for pneumonia and sepsis, [19,25,28] Management of suspected cases…”