SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Abstract

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.

Prevalence and Obstetric Management Changes During the COVID-19 Pandemic in Peripartum SARS-CoV-2-Positive Women – an Analysis of the CRONOS Registry Data

“…Adjusted screening testing increased over 75% in neonates admitted to the NICU in accordance with that guideline. Clinical management of mothers also changed when an increased risk of thromboembolic events due to SARS-CoV-2 infection, especially during pregnancy, became apparent 10 . After that, CRONOS recorded a definite increase in heparin prescription to pregnant women with symptomatic SARS-CoV-2 infection.…”

“…To achieve those goals, intensive, personal, and preferably one-on-one obstetric care is key [22,23]. Over time, it was shown that vaginal deliveries of SARS-CoV-2-positive women were not generally associated with a higher risk of adverse events for mother or newborn [10,15,24]. In recent analyses, CRONOS and others found that the highest risk of suffering from severe COVID-19 occurred when infected around 30 weeks of gestation [11,19].…”

“…Once it became clear that SARS-CoV-2 infection rarely affects neonates [8,24], an increase delayed cord clamping proportion from initially 46 % in the first wave of the pandemic in 2020 to finally 67 % in the fifth wave in 2022 reflects successful guideline implementation. Similarly, unnecessary general neonate screening tests decreased by 15 % after recommendations [10] were updated. Adjusted screening testing increased over 75 % in neonates admitted to the NICU in accordance with that guideline.…”

“…In addition, data from CRONOS and similar sources was used to create new frequently updated national guidelines. [10] In this study, we used CRONOS data with the aim to analyse infection prevalence among parturients and to assess changes in obstetric management over time. We hypothesised: 1) a high incidence of SARS-CoV-2 infections in pregnant women in comparison to the general population over the phases of the pandemic as recorded by the Robert Koch-Institute (RKI) because of strict screening processes in German maternity units.…”

“…In addition, data from CRONOS and similar sources was used to create new frequently updated national guidelines. 10 In this study, we used CRONOS data with the aim to analyse infection prevalence among parturients and to assess changes in obstetric management over time. We hypothesised:…”