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Pregnant lady with COVID-19 (II.)

Should mothers with COVID-19 be separated from their babies?


Pregnant lady with COVID-19 (II.)


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Can an asymptomatic partner/support person attend labor & delivery?


This is practicably variable. At least, the supportive person should be screened first according to the local policy, and subjects with:

1)    any Sms consistent e COVID-19,

2)    exposed to a confirmed case through 14 d., or

3)    +ve test for COVID-19 through 14 d.

Should NOT be permitted to attend the labor & birth.

Most facilities recommend that a supportive subjects is important to many laboring women and allow one supportive subject who must attend with the laboring lady (may NOT leave the labor room and then return). Further supportive subjects may be permitted or can be a part of the ptn's labor & delivery through a video.  


POSTPARTUM: How should the baby be evaluated?


If the mother with a documented COVID-19 infection, the infant is a COVID-19 suspect and should be examined for COVID-19, isolated from healthy infants, and managed accordingly to infection control measures for ptns with confirmed/ suspected COVID-19 infection.


Should mothers with COVID-19 be separated from their babies?


Generally speaking, NO as the newborn's risk to acquire SARS-CoV-2 from his/her mother is currently low, and the available data suggest that there is  no difference in risk of neonatal SARS-CoV-2 transmitted infection whether this neonate is currently cared in a separate room or still remaining in his/her mother's room. However, nursing mothers must wear a mask with the necessary hand hygiene within caring their babies. Physical distance more than 6 feet between the mother & the baby or keeping the baby in an incubator is advised, however, after contact.


How long mother-baby precautions at home should be continued after recent infection?


Prior symptomatizing mother with suspected/confirmed COVID-19 are NOT considered a possible risk of viral transmission to their babies if they hv met the criteria to hold discontinuing isolation and precautions:

v  At least 10 d. should pass since their Sms firstly manifested (up to 20 d. if they hv more intense clinical illness or are seriously immunocompromised).

v  At least 24 h. hv passed since last feverish episode with no antipyretics use.

v  Other symptomatology have been ameliorated.

Asymptomatic mother recognized only by obstetric screening testing, at least 10 d. should have elapsed since the last positive testing.  


Can breast milk transmit SARS-CoV-2?


Generally, breastfeeding should be advised owing to its several maternal & infant benefits.

 It’s uncertain whether SARS-CoV-2 can be transmitted through breast milk feeding as a few breast milk samples hv bn examined. In a WHO report, breast milk samples taken from 43 mothers were negative for SARS-CoV-2 by the RT-PCR) & samples from 3 mothers tested +ve, but the particular tests for viable & infective virus have not been adressed.


What are the precautions should mothers with confirmed / suspected COVID-19 take when breastfeeding?


Droplet viral transmission from infected mothers to their babies is currently possible via close contact during breastfeeding their babies. Mothers may consider the necessary precautions through hand & breast hygiene and the use of a face mask. In a New York City report testing 82 baby of 116 mo who tested +ve for SARS-CoV-2, No one baby was +ve for SARS-CoV-2 post-natally, despite that most roomed-in with their mothers and on breastfeeding. The baby was kept in a closed isolette while rooming-in, and his mother wore a surgical mask while handling their babies and was following frequent hand & breast washing measures.

Alternative procedure is that the infant can be fed an expressed breastmilk by a healthy caregivers following hygiene protocols until the mother has been completely recovered. In such cases, the mother should use strict handwashing prior to pumping and with wearing a face mask within pumping procedure.  


Can pregnant & postpartum lady with COVID-19 take NSAIDs & acetaminophen?


The answer is Yes, NSAIDs agents & acetaminophen can be administrated to control fever & pain during pregnancy & postpartum. The lowest effective dose should be administrated. In ptns with abnormal liver profile due to COVID-19, a particular concern of acetaminophen therapy is hepato-toxic; however, a dose < 2 g./d. are likely safe in absence of advanced or severe hepatic failure. Concern about possible negative effects of NSAIDs was provided by anecdotal reports of a few young, non-pregnant ptns receiving NSAIDs (ibuprofen) early in the course of infection and experienced intense disease.

Subsequent clinical or population-based data on risk of NSAIDs in COVID-19 still limited. Given this uncertain findings, acetaminophen administration as a preferred analgesic if possible, and if NSAIDs are needed, the lowest effective dose must be utilized. The American College of Obstetricians & Gynecologists, the European Medicines Agency, & the WHO, ALL recommend not to avoid NSAIDs if it is  clinically indicated.