From the Journals

Screen pregnant women with suspected 2019-nCoV infection

Publish date: February 10, 2020
Author(s):
Mark S. Lesney

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Screen, test, treat pregnant patients with severe respiratory illness

The coronavirus has been spreading rapidly in China, and recently, international cases have been identified, including within the United States. As the article by Locher et al. suggests, mechanical, physiological, and immune adaptations in pregnancy leave pregnant women at risk of severe complications from respiratory illnesses.

Obstetricians need to be prepared to screen, test, and promptly treat pregnant women with any severe respiratory illness to reduce maternal and perinatal morbidity. At this time, the Centers for Disease Control and Prevention advises that any patient with fever and signs of a lower respiratory infection, as well as an epidemiologic risk factor (such as recent travel to China), should be considered at risk for the coronavirus. Samples are collected and sent to the CDC as testing can be done only at the CDC at this time. Please refer to the CDC website for up-to-date guidance for health care professionals.

Unfortunately, there is no specific treatment for coronavirus. Clinical management includes prompt implementation of recommended infection prevention and control measures. Supportive management of complications, including fever reduction and advanced organ support, should be provided as necessary.

While coronavirus is a terrifying potential threat, it’s worth mentioning that, for most pregnant women, a much more likely threat is influenza. Pregnant women with influenza virus infection are at increased risk for progression to pneumonia, ICU admission, preterm delivery, and maternal death. The influenza vaccine can help reduce these risks, and we should continue to encourage vaccination for all pregnant women. Prompt treatment is important! Treatment within 48 hours of the onset of symptoms is ideal, but treatment should not be withheld if the ideal window is missed.

Finally, don’t forget to remind your pregnant patients to avoid close contact with sick family members and friends, wash hands frequently, and call the doctor’s office with any sign of a flu-like illness!

Angela Martin, MD, is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at the University of Kansas Medical Center in Kansas City. She is a member of the Ob.Gyn. News editorial advisory board.


 

FROM THE LANCET

It is too early yet to explicitly determine the effects of the Novel Coronavirus (2019-nCoV) on pregnant women and their fetuses. This is a critical concern, because members of the coronavirus family, which have been responsible for previous outbreaks of severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), have demonstrated their ability to cause severe complications during pregnancy, according to researchers.

The SARS virus outbreak and the more recent MERS virus outbreak provide the best available models with which to examine the potential impact of 2019-nCoV on pregnancy, according to a letter published online in the Lancet.

Twelve pregnant women were infected with SARS-CoV during the 2002-2003 pandemic. Three (25%) of these women died during pregnancy. Overall, four of seven women had a miscarriage in the first trimester. In the second or third trimester, two out of five women had fetal growth restriction, and four of the five had preterm birth (one case was spontaneous and three were induced because of the maternal condition), according to corresponding author David Baud, MD, PhD, of the maternal-fetal and obstetrics research unit at Lausanne (Switzerland) University Hospital, and colleagues.

A review of 11 pregnant women infected with the virus showed that 10 women (91%) presented with adverse outcomes. Six (55%) neonates were admitted to the ICU; three (27%) died. Two neonates were delivered prematurely because their mothers developed severe respiratory failure.

Because 2019-nCov has a potential for similar behavior, “we recommend systematic screening of any suspected 2019-nCoV infection during pregnancy. If 2019-nCoV infection during pregnancy is confirmed, extended follow-up should be recommended for mothers and their fetuses,” concluded Dr. Baud and colleagues.

Dr. Baud and associates are known for their previous research on the impacts of the Zika virus on pregnancy. They reported having no competing interests.

SOURCE: Baud D et al. Lancet. 2020 Feb 6. doi: 10.1016/S0140-6736(20)30311-1.

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