COVID

Question 1

How is COVID transmitted?

Answer 1

Respiratory droplets or secretions
Faeces
Fomites (on objects)

Question 2

What are the inpatient case criteria for COVID

Answer 2

Anosmia
Clinical / radiological pneumonia
ARDS
Fever 37.8 + AND
- acute persistent cough
- hoarseness
- nasal discharge / congestion
- sore throat
- sneezing
- dyspnoea
- wheezing

Question 3

What are the radiological investigations that are important in assessing COVID?

Answer 3

CXR
CT Chest

Should not be delayed due to fetal concerns. Maternal safety is paramount

Question 4

What VTE prevention is used in COVID in pregnancy?

Answer 4

Clexane
BUT COVID has been associated with thrombocytopenia, so if Plt <50, stop Clexane and discuss with Haem

Mechanical aids

Question 5

What has the RECOVERY Trial shown?

Answer 5

Steroids for 10/7
(Prednisolone 40mg po bd OR Hydrocorstine 80mg IV bd)

Reduction in 28-day mortality in patients with COVID requiring O2

Question 6

Should IVAB be prescribed for COVID in pregnancy?

Answer 6

Low threshold, while waiting for swab result.

Even after swab result available, consider continuing because of the risk of superimposed bacterial infection

Question 7

What are the risk factors associated with getting COVID AND being hospitalised with it?

Answer 7

Black, Asian and minority ethnic race
BMI > 25
Pre-pregnancy comorbidity
Maternal age > 35
Socioeconomic deprivation

AND public-facing occupations e.g. healthcare

Question 8

What are the two effects of COVID on pregnancy / obstetric outcomes?

Answer 8

Increased risk of PTB with OR 3 (small study, low quality)
- 94% iatrogenic

Increased risk of CS

Question 9

Does COVID have an impact on the rate of

• congenital anomalies
• stillbirth / NND
• IUGR

Answer 9

No

Question 10

Patients with COVID >20/40 are ____ x more likely to be admitted to ICU than those <20/40

Answer 10

5!

Question 11

Is CEFM required in a woman with COVID?

Answer 11

Only if symptomatic

If asymptomatic and tests positive, CEFM not required

Question 12

Is FBS / FSE okay with COVID?

Answer 12

Yes

Question 13

Can mums with COVID breastfeed

Answer 13

Yes

Question 14

What are the labour analgesia recommendations for women with COVID-19?

Answer 14

Minimise risk of GA by providing early epidural.

Entonox is safe to use with single patient microbiological filter.

Question 15

What are the recommendations for birthing partners?

Answer 15

Screen all birthing partners for sx.
One one birthing partner allowed. Asymptomatic birthing partners should wear face mask etc.
If asymptomatic, can stay with woman.
If fever in last 48 hours, need to self isolate regardless of test result.
If symptoms in last 10 days, need to self-isolate until negative test result after onset of sx.

Question 16

What should occur when a woman who is COVID-19 positive and symptomatic is admitted to birthing suite in labour?

Answer 16

Assessment by most senior clinician:

• Severity of sx
• Observations
• Confirmation of onset of labour
• CTG

Inform MDT of woman’s presence.

Question 17

Should women diagnosed with COVID-19 in pregnancy have serial growth scans and why?

Answer 17

Yes

2/3rds of SARS affected pregnancies for FGR; no evidence of same in COVID-10 but is recommended.