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In an unprecedented situation, unprecedented care. While France is placed in confinement to slow the progression of the new coronavirus, many questions arise as to the monitoring and care of pregnant women, especially when they are close to the term.
Let us recall that in its opinion of March 13, the High Committee of Public Health considers that “pregnant women by analogy with the series published on MERS-CoV and SARS“And”despite a small series of 18 cases of SARS-CoV-2 infections showing no increased risk for either mother or child“, are among those at risk to develop a severe form of infection with the novel coronavirus.
In a press release, the Syndicat des gynecologues obstétriciens de France (SYNGOF) indicates that the care of pregnant women is maintained, but that teleconsultation should be privileged as much as possible. The three mandatory ultrasounds are maintained,but hygiene precautions (spacing of patients in the waiting room, disinfection of the room, barrier gestures, etc.) must be strictly observed. “Patients must come to the practice alone, without an accompanying person and without children”, Indicates the SYNGOF.
In addition, the National College of Midwives indicated postponement of collective childbirth preparation sessions and perineal rehabilitation sessions. He advises midwives to favor individual consultations and to space them out in time, in order to avoid the accumulation of patients in the waiting room.
In a tweet published this Tuesday, March 17 in the morning, the President of the National College of Midwives of France Adrien Gantois indicated that in the absence of a response from the Ministry of Health at 14 p.m. concerning access to surgical masks and in telemedicine for the profession, he would ask liberal midwives to close their practices. This March 17 afternoon, he said he had “positive oral information” from the government regarding telemedicine for liberal midwives, but without further details. It also advises against using the Skype platform since it does not guarantee any protection of health data.
At present, the College of Obstetrician Gynecologists indicates that there is no no systematic hospitalization of pregnant women with confirmed infection or while waiting for the result. They simply have to “keep the mask outside”, And follow a“outpatient monitoring procedure according to the local organization“.
That said, a patient in the third trimester of pregnancy and / or overweight is part of the list of officially recognized comorbidities, according to the CNGOF, and must therefore be hospitalized in the event of a suspected or proven Covid-19 infection.
In this case, the REB referent (for Epidemiological and Biological Risk) of the department is consulted and will make decisions in connection with the host obstetric team. “For some hospitals, it is recommended to transfer the possible patient to a referral hospital so that the sample is carried out optimally without having to transport the sample.”, Details the CNGOF.
The management is then adapted according to the respiratory criteria of the patient and her obstetrical state. (labor in progress, imminent delivery, hemorrhage or other). The induction of labor can then be undertaken, but in the absence of complications, the pregnant patient with coronavirus can also simply be closely monitored and placed in isolation.
Childbirth in confinement: what happens for visits to the maternity ward?
Maternity visits are obviously limited, usually to one person, most often the father of the child or the person who lives with the mother.
In the absence of symptoms or proven infection with Covid-19 both in the pregnant woman and her spouse or accompanying person, the latter may be present in the delivery room. On the other hand, in the event of symptoms or proven infection, the CNGOF indicates that the pregnant woman must be alone in the labor room.
Mother-child separation after birth is not recommended
At this stage, and in view of current scientific data, the SFN (French Society of Neonatology) and the GPIP (Pediatric Infectious Pathology Group) do not currently recommend mother-child separation after childbirth and does not contraindicate breastfeeding, even if the mother is a carrier of Covid-19. On the other hand, the wearing of a mask by the mother and strict hygiene measures (systematic hand washing before touching the infant) are required. “No mask for the child!”, Also specifies the National College of Obstetrician Gynecologists (CNGOF).
sources: CNGOF, SYNGOF & CNSF