Labor and delivery guidance for COVID-19

COVID-19 disease is a global pandemic caused by a novel coronavirus, labelled as SARS-CoV-2. Currently, more than 100 million women are pregnant with more than 100 million fetuses worldwide, virtually all of whom are at risk for COVID-19. Pregnant women are somewhat immunosuppressed and thus may be at higher risk from developing severe disease from COVID-19, in particular pneumonia and respiratory failure. Early data from a meta-analysis of 41 pregnant women with COVID-19 shows that they have a higher risk of miscarriage, preterm birth, preeclampsia, and cesarean delivery, particularly if they are hospitalized with pneumonia.1 Their babies are at higher risk of stillbirth (2.4%, 1/41 so far), neonatal death (2.4%, 1/41) and admission to the intensive care unit.1 Asymptomatic women and women with mild disease have fewer complications. General guidance regarding prevention and management of COVID-19 in pregnancy has been published.2-5 Regarding outpatient prenatal care, maternal-fetal medicine guidance for COVD-19 has been recently published.6 It is currently estimated that over one-third and up to twothirds of the world population may be infected with COVID-19.7 Many of the 145 million annual births in the world are at risk, including the about 400,000 which give birth daily. This document addresses the current COVID-19 pandemic for providers and patients in labor and delivery (L&D). The goals are to: ● Provide guidance regarding methods to appropriately screen and test pregnant patients for COVID-19 prior to, and at admission to L&D, ● Reduce risk of maternal and neonatal COVID-19 disease through minimizing hospital contact and appropriate isolation, ● Provide specific guidance for management of L&D of the COVID-19 positive woman, as well as the critically-ill COVID-19 positive woman. The first 5 sections deal with L&D issues in general, for all women, during the COVID-19 pandemic. These include: Section 1: Appropriate screening, testing and preparation of pregnant women for COVID-19 before visit and/or admission to L&D; Section 2: Screening of patients coming to L&D triage; Section 3: General Changes to Routine L&D Work Flow; Section 4: Intrapartum care; Section 5: Postpartum care. Section 6 deals with special care for the COVID-19 positive or suspected pregnant woman in L&D. Section 7 deals with the COVID-19 positive/suspected woman who is critically-ill.