Coronavirus disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, is rapidly spreading across the world. As the number of infections increases, those of infected pregnant women and children will rise as well. Controversy exists whether COVID-19 can be transmitted in utero and lead to disease in the newborn. As this chance cannot be ruled out, strict instructions for the management of mothers and newborn infants are mandatory. This perspective aims to be a practical support tool for the planning of delivery and neonatal resuscitation of infants born by mothers with suspected or confirmed COVID-19 infection.

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.

All relevant resources for managing the pregnant woman during the COVID-19 pandemic in South Africa.

Version 4,  18 May 2020

Algorithm for pregnancy in the COVID-19 pandemic