COVID-19 Advice for Pregnant Women

This advice is based on a combination of available evidence, good practice, and expert advice. This advice is intended to reduce transmission of COVID-19 to pregnant women, and provide safe care to pregnant women with suspected or confirmed COVID-19.
The virus can be isolated from respiratory secretions, faeces and fomites (inanimate objects). Pregnant women do not appear more likely to contract the infection than the general population. Pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally cause more severe symptoms. This will be the same for COVID-19. 
With regard to transmission from mother to baby before or during birth, this is probable although the proportion of pregnancies affected and the significance to the neonate has yet to be determined. Two reports have published evidence of antibodies in newborn serum at birth. This is likely to represent a neonatal immune response to in utero infection. Previous case reports from China have offered no evidence for this, based on testing all fluids of mother and baby at the time of birth, including breast milk. Data is being collected. 
Effect on the Pregnant Woman
Most women will experience only mild or moderate flu-like symptoms. Cough, fever and shortness of breath are also common. More severe symptoms may occur towards the end of pregnancy. Symptoms should be identified and treated properly. The absolute risk is however small. Although the reported cases of COVID-19 in pregnancy are mild with good recovery, there is only one published case of a woman with severe COVID-19 admitted at 34 weeks gestation, had emergency Caesarean birth for a still-born baby and was admitted to the intensive care unit. In another study there was increased risk of preterm birth indicated for maternal medical reasons in one case at 28 weeks gestation with a different Coronavirus infection (Sars/Mers). 
The effect on the foetus
There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Moreover, case reports from studies with other Coronaviruses do not demonstrate a relationship between infection and increased risk of miscarriage or second trimester loss. 
There is no evidence currently that the virus is teratogenic. The risk of infection to the neonate has yet to be determined.
In one case of preterm birth in a woman with COVID-19 there was evidence of foetal compromise and prelabour preterm rupture of the membranes. 
Advice for Pregnant Women
If you have symptoms of COVID-19 please contact your maternity team and they will arrange the right place and time to come for your visits. You should not attend a routine clinic.
- You will be asked to come alone to clinic appointments, or to keep the number of people with you to one.
- If you have any concerns, please contact your maternity team using the same details you already have.
- It is important to self-isolate because of your increased risk prior to and for two weeks following delivery. 
This is based on advice from the Royal College of Obstetricians and Gynecologists
To read about what labour is like with Marfan syndrome check out Laura Smith's blog post Going in to Labour with Marfan sydrome
COVID-19 Advice for Pregnant Women
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