SARS-CoV-2 infection management in pregnant patients. All we know by now about COVID-19 in pregnancy

Abstract

SARS-CoV-2 – a novel enveloped RNA beta-coronavirus – infects host respiratory epithelial cells. Patients with COVID-19 manifest a spectrum of upper and lower respiratory tract symptoms. Social distancing measures have proven to be effective in reducing the disease transmission. There are limited data on the impact of the current COVID-19 outbreak on women affected during pregnancy and on the fetal impact, but the clinical manifestations of infection in pregnancy seem to be similar to those in non-pregnant adults, with no evidence of higher mortality. To date, no evidence sustains the vertical transmission of SARS-CoV-2 from amniotic fluid, cord blood, placenta and neonatal nasopharyngeal swab samples. For low-risk pregnancy, during current pandemic, antenatal appointments should be reduced to minimum; pregnancy-associated pathology should not be neglected. Non-face-to-face medical counseling should be maximized, thus protecting both the patient and the health care providers. Routine confirmation of cases with SARS-CoV-2 infection is based on the detection of unique sequences of virus RNA by real-time reverse-transcription polymerase chain reaction (rRT-PCR). The management should be symptomatic and supportive, including fluid and electrolyte balance, oxygen supply, antibacterial and antiviral treatment in selected cases, LMWH to all pregnant COVID-19 patients requiring admission, fetal monitoring and individualized timing and mode of delivery. Several vaccines are under development and will be available in the future.