New guidance for maternity services issued in light of Covid-19

Pregnant healthcare workers should be assigned to patients and duties that have reduced exposure to patients with, or suspected to have, Covid-19, according to new guidance from the RCPI Institute of Obstetricians and Gynaecologists on Covid-19 and maternity services. 

Published on 3 April, the guidance advises that pregnant healthcare workers are an “at-risk group for Covid-19 infection” and therefore should not be rostered to work on “Covid-specific units or wards”. 

Redeployment to lower risk duties should be considered and any pregnant staff with an underlying medical condition should discuss redeployment or working from home with their treating obstetrician. 

The guidance also recommends pregnant women have one birthing partner with them during labour “unless this partner is symptomatic or unwell, irrespective of the woman’s Covid-19 status”. 

According to the World Health Organisation (WHO), a positive childbirth experiences includes having a birthing partner of choice present during delivery. 

But the guidance notes that it may not be possible, in some situations, for a partner to be present during delivery. 

“In situations where the woman has or is suspected to have Covid-19 infection there may be situations where regrettably this is not possible relating to PPE [personal protective equipment] availability, workforce gaps or unit configuration. Local policies may also apply for the partner to wear PPE, and to stay in the room for the duration of the labour or delivery. 

“In emergency scenarios for Covid-19 positive women…it may not be feasible for the partner to attend the delivery in theatre.”

Women, the guidance states, with suspected or confirmed Covid-19 who are in labour should be placed in an isolation room with en suite facilities. 

No maternal deaths from the virus have been reported to date and pregnant women do not appear more likely to contract Covid-19 than the general population, the guidance advises.

But pregnancy “predisposes women to complications of viral infection” and “pregnant women are more likely to develop severe illness after infection with respiratory viruses,” it is stated.

To date there is no data on first trimester infection. A rise in the risk of miscarriage in women affected by Covid-19 cannot be ruled out, however, as pregnant women who develop a fever, or who have a serious illness, in their first trimester of pregnancy are considered to have an increased risk of miscarriage. 

Furthermore, in women affected by SARS, for example, there was a higher pregnancy loss rate and more pregnancy complications were reported.

Mother to baby transmission of Covid-19 is now considered “probable”, the guidance states, but “the proportion of pregnancies affected and the significance to the neonate has yet to be determined”. 

The guidance was written by Dr Keelin O’Donoghue, Consultant Obstetrician at Cork University Maternity Hospital (CUMH) and Principal Investigator at University College Cork’s (UCC) INFANT Research Centre; and Joye McKernan, National Perinatal Epidemiology Centre.