In particular UW MFM's guidelines recommend more intervention and St Mary's MFM doesn't recommend substantially different care from non-COVID+ patients. This includes a whether to recommend anticoagulation and timing of induction
UW/Meriter Guidance for antenatal patients as of 12/15/20 - document here and highlights below:
Patients who have tested positive for COVID 19 and are asymptomatic should have their COVID status updated in the medical record and provided with guidelines for when to seek care if symptoms worsen.
Patients who have tested positive for COVID 19 and are experiencing symptoms should be scheduled for a video visit with a provider to determine severity of illness.
The video visit should be scheduled ASAP (same day or next day) with primary OB/CNM or APP.
If it is determined that the patient is experiencing mild COVID symptoms, the provider will inform patient of guidelines for when to seek care if symptoms worsen.
If patient is diagnosed with COVID at any point in pregnancy and is experiencing moderate to severe symptoms, the provider will order 10 days of Lovenox injections per new guidelines. RNs can assist with care coordination.
Patients testing positive in the 3rd trimester and experiencing moderate to severe symptoms will be scheduled for a weekly AFI & NST at Arb clinic, during isolation period only and will then be done at local clinics.
If Lovenox injections are indicated, a telemed visit will be scheduled with a RN to perform injection teaching with the patient. (If patient is scheduled for an in person essential visit then injection teaching could be done at that time)
RN to send video/written instructions on how to administer subQ injections to patient via MyChart and review during the telemed teaching call. More to come on Lovenox teaching resources.
28-32-36 week growth ultrasounds should be scheduled (at any of our clinics) if a patient tests positive at any point in their pregnancy.
During acute illness, fetal management should be similar to that provided to any critically ill pregnant person. Continuous fetal monitoring in the setting of severe illness should be considered only after fetal viability, when delivery would not compromise maternal health or as another noninvasive measure of maternal status.
Very little is known about the natural history of pregnancy after a patient recovers from COVID-19. In the setting of a mild infection, management similar to that for a patient recovering from influenza is reasonable. It should be emphasized that patients can decompensate after several days of apparently mild illness, and thus should be instructed to call or be seen for care if symptoms, particularly shortness of breath, worsen. Given how little is known about this infection, a detailed mid-trimester anatomy ultrasound examination may be considered following pre-pregnancy or first-trimester maternal infection. Interval growth assessments could be considered depending on the timing and severity of infection, with the timing and frequency informed by other maternal risk factors. Antenatal testing is reserved for routine obstetrical indications (SMFM Coronavirus COVID-19 and Pregnancy).
ACOG will continue to carefully monitor the literature to provide our members with the best available and most current guidance. Should new literature indicate any need for additional antenatal fetal surveillance for pregnant patients with suspected or confirmed COVID-19, ACOG will update our recommendations accordingly.