Version 4,  18 May 2020

Algorithm for pregnancy in the COVID-19 pandemic

Two important fundamental principles have been re- peatedly emphasized concerning maternal coronavirus infection during pregnancy. First, limited available evi- dence suggests that the coronavirus (SARS-CoV and SARS-CoV-2) is unlikely to be transmitted vertically from mothers to babies (even in preterm infants) [7], though recent reports indicated that newborns could ac- quire SARS-CoV-2 infection postnatally within days after birth. Secondly, maternal SARS or COVID-19 infection per se should not be an indication for early delivery. The timing and mode of delivery should solely be determined by the maternal respiratory status (e.g., progressive dete- rioration with increasing need for oxygen supplementa- tion, escalation of ventilatory support due to increasing fetal size with splinting of diaphragmatic movement, and restriction of chest expansion in compromised infected lungs, resulting in respiratory failure), and obstetric indications.