Systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy

Girolamo, Raffaella Di; Khalil, Asma; Rizzo, Giuseppe; Capannolo, Giulia; Buca, Danilo; Liberati, Marco; Acharya, Ganesh; Odibo, Anthony O.; D’Antonio, Francesco

doi:10.1016/j.ajogmf.2022.100654

Cited by 16 publications

(23 citation statements)

References 33 publications

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“…Our study also found that many women experienced changes in labor and delivery care, especially shifts from planned hospital to home birth or from vaginal to C-section delivery. Previous studies have reported different findings about changes in the incidence of C-section, with some reporting no change [30], decreased rates [31,32], and others slightly increased rates [33], despite no evidence for a change in the indication for C-section in the context of the COVID-19 pandemic [7,34]. Such changes in access and quality of prenatal care and labor and delivery services are likely important contributors to emotional stress during pregnancy, a finding observed elsewhere due to the impact of COVID-19 and in the context of previous pandemics [35].…”

Section: Discussionmentioning

confidence: 93%

“…This elevated risk for pregnant individuals and their infants emphasizes the need for individuals to closely follow preventive measures to protect against SARS-CoV-2 infection and consider seeking COVID-19 vaccination. Many clinical practice guidelines for management of SARS-CoV-2 infection in pregnancy have been developed, but there is need for greater consensus and promotion of evidencebased guidelines for this purpose by national and international professional societies [7].…”

Section: Introductionmentioning

confidence: 99%

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Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic

Erchick

Agarwal

Kaysin

et al. 2022

BMC Pregnancy Childbirth

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Introduction Concerns about SARS-CoV-2 infection risk in health care settings have resulted in changes in prenatal care and birth plans, such as shifts to in-person visits and increased Cesarean delivery. These changes may affect quality of care and limit opportunities for clinicians to counsel pregnant individuals, who are at higher risk of severe COVID-19 disease and adverse pregnancy outcomes, about prevention and vaccination. Methods We conducted a cross-sectional online survey of United States adults on changes in prenatal care, COVID-19 vaccine willingness, and reasons for unwillingness to receive a vaccine. We summarized changes in access to care and examined differences in vaccine willingness between pregnant and propensity-score matched non-pregnant controls using chi-squared tests and multivariable conditional logistic regression. Results Between December 15–23, 2020, 8481 participants completed the survey, of which 233 were pregnant. Three-quarters of pregnant women (n = 186) experienced a change in prenatal care, including format of care (n = 84, 35%) and reduced visits (n = 69, 24%). Two-thirds experienced a change in birth plans, from a hospital birth to home birth (n = 45, 18%) or vaginal birth to a Cesarean delivery (n = 42, 17%). Although 40% of pregnant women (n = 78) were unwilling to receive COVID-19 vaccination, they had higher, though non-significant, odds of reporting willingness to receive vaccination compared to similar non-pregnant women (aOR 1.38, 95% CI: 0.95, 2.00). Conclusion To support pregnant women through the perinatal care continuum, maternity care teams should develop protocols to foster social support, patient-centered education around infection prevention that focuses on improved risk perception, expected changes in care due to COVID-19, and vaccine effectiveness and safety.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic

Erchick

Agarwal

Kaysin

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…A recent review found evidence for the effectiveness of virtual wards deploying pulse oximetry alone to be limited, though only one study of maternity patients was included in the analysis [11]. Indeed, while current clinical practice guidelines for management of COVID-19 in pregnancy vary, there remains general consensus that women should be monitored at home if possible, and hospitalised only in the case of respiratory distress, elevated respiratory rate or low oxygen saturation [12]. A need for development of shared guidelines has also been identified [12].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, while current clinical practice guidelines for management of COVID-19 in pregnancy vary, there remains general consensus that women should be monitored at home if possible, and hospitalised only in the case of respiratory distress, elevated respiratory rate or low oxygen saturation [12]. A need for development of shared guidelines has also been identified [12].…”

Section: Introductionmentioning

confidence: 99%

“…As volumes increased, a system of triage was developed to cope with demand. We outline the Virtual Ward technology, intervention and staffing model, readmission rates, as well as the specific triage criteria and alarm settings used, as an example of an operational model for other institutions and as a contribution to the emerging consensus around best care [12].…”

Section: Introductionmentioning

confidence: 99%

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Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

Bircher

Wilkes²,

Zahradka³

et al. 2022

BMC Pregnancy Childbirth

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Background During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom. Methods Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions. Results Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology. Conclusions The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

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COVID‐19 vaccine and pregnancy outcomes: A systematic review and meta‐analysis

Carbone

Trinchillo

Girolamo

et al. 2022

Intl J Gynecology & Obste

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Objectives To explore perinatal outcomes in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐vaccinated pregnant women compared with unvaccinated counterparts. Methods Search was conducted using Web of Science, Scopus, ClinicalTrial.gov, MEDLINE, Embase, OVID, and Cochrane Library as electronic databases. We included observational studies evaluating pregnant women undergoing SARS‐CoV‐2 vaccination and compared pregnancy and perinatal outcomes with those in unvaccinated women. Categorical variables were assessed using odds ratio (OR) with 95% confidence interval (CI), whereas for continuous variables, the results were expressed as mean difference with their 95% CI. All analyses were performed by adopting the random effect model of DerSimonian and Laird. Results There was no difference in the probability of having a small‐for‐gestational‐age fetus (OR 0.97, 95% CI 0.85–1.09; P = 0.570), but we observed a reduced probability of a non‐reassuring fetal monitoring, a reduced gestational age at delivery, and a reduced probability of premature delivery in vaccinated pregnant women versus unvaccinated ones. Conclusion The probability of small for gestational age is similar between vaccinated and unvaccinated pregnant women, and the former also had a slightly reduced rate of premature delivery.

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Systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy

Cited by 16 publications

References 33 publications

Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic

Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic

Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

COVID‐19 vaccine and pregnancy outcomes: A systematic review and meta‐analysis

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