Management of obstetrics and gynaecological patients with COVID-19

ABSTRACT The widespread SARS-CoV-2 implies the application of procedures aimed to detect, isolate, and appropriately manage affected patients in the setting of obstetrics and gy- naecologic emergency room and in inpatient setting, such as during labour, delivery, and postpartum. Here we report specific recommendations for the management of sus- pected and confirmed gynaecologic and obstetrics patients with COVID-19. The checklist developed by the Società Italiana di Malattie Infettive e Tropicali (SIMIT-2, available in English, Italian, Chinese) represents the first step to clas- sify patients who need to be managed following the SIMIT- 1 flowchart, applying all the appropriate infection control procedures. In this scenario, the management of pregnant women needs to follow the same procedures as the general population. Nevertheless, as for other potentially severe respiratory infections, pregnant women could be more vul- nerable. In this regard, the maternal and foetal interests can be conflicting, such as the choice of the time and mode of delivery or the use of steroids for foetal maturation. More- over, available evidence suggests a maternal-foetal trans- mission via contact with respiratory secretions and seems to exclude in utero transmission. Therefore, the appropriate management of breastfeeding is unclear, and the tempo- rary separation of the infant from the mother could be an option. Finally, in general, delivery represents a moment of a high risk of infection for healthcare providers, and spe- cific behaviours are mandatory.