Learn, engage, and connect with your ACOG community during two half-days of clinical seminars, panel discussions, clinical debates, poster sessions, and more. Join ACOG today to access career support, the latest clinical guidance in women's health, patient education materials, and more. The Global Women's Health program aims to improve women's health globally through capacity building, collaboration, and health system strengthening. We're working to lower the unintended pregnancy rate in the US by providing the most up-to-date information on LARC methods and increasing access to contraception. Bulk pricing was not found for item.
For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the last menstrual period alone, should be used as the measure for gestational age.
For instance, the EDD for a pregnancy that resulted from in vitro fertilization should be assigned using the age of the embryo and the date of transfer. As soon as data from the last menstrual period LMPthe first accurate ultrasound examination, or both are obtained, the gestational age and the EDD should be determined, discussed with the patient, and documented clearly in the medical record. For the purposes of research and surveillance, the best obstetric estimate, rather than estimates based on the LMP alone, should be used as the measure for gestational age.
An accurately assigned EDD early in prenatal care is among the most important results of evaluation and history taking. This information is vital for timing of appropriate obstetric care; scheduling and interpretation of certain antepartum tests; determining the appropriateness of fetal growth; and designing interventions to prevent preterm births, postterm births, and related morbidities. Appropriately performed obstetric ultrasonography has been shown to accurately determine fetal gestational age 1.
A consistent and exacting approach to accurate dating is also a research and public health imperative because of the influence of dating on investigational protocols and vital statistics. This Committee Opinion outlines a standardized approach to estimate gestational age and the anticipated due date.
ABSTRACT: Accurate dating of pregnancy is important to improve outcomes and is a research and public health imperative. As soon as data from the last menstrual period, the first accurate ultrasound examination, or both are obtained, the gestational age and the estimated due date (EDD) should be determined, discussed with the patient, and documented clearly in the medical record. The American College of Obstetricians and Gynecologists is the premier professional membership organization for obstetrician-gynecologists. The College's activities include producing practice guidelines for providers and educational materials for patients, providing practice management and career support, facilitating programs and initiatives aimed at improving women's health, and. Defining a Suboptimally Dated Pregnancy. The American College of Obstetricians and Gynecologists considers first-trimester ultrasonography to be the most accurate method to establish or confirm gestational age truthexchange-sow.com the second and third trimesters, ultrasonographic biometric dating has a range of inaccuracy that increases with advancing gestational age.
However, there is great usefulness in having a single, uniform standard within and between institutions that have access to high-quality ultrasonography as most, if not all, U. Accordingly, in creating recommendations and the associated summary table, single-point cutoffs were chosen based on expert review.
Because this practice assumes a regular menstrual cycle of 28 days, with ovulation occurring on the 14th day after the beginning of the menstrual cycle, this practice does not account for inaccurate recall of the LMP, irregularities in cycle length, or variability in the timing of ovulation. It has been reported that approximately one half of women accurately recall their LMP 2 3 4.
Accurate determination of gestational age can positively affect pregnancy outcomes. For instance, one study found a reduction in the need for postterm inductions in a group of women randomized to receive routine first-trimester ultrasonography compared with women who received only second-trimester ultrasonography 5.
A Cochrane review concluded that ultrasonography can reduce the need for postterm induction and lead to earlier detection of multiple gestations 6. Because decisions to change the EDD significantly affect pregnancy management, their implications should be discussed with patients and recorded in the medical record.
Measurements of the CRL are more accurate the earlier in the first trimester that ultrasonography is performed 11 15 16 17 The measurement used for dating should be the mean of three discrete CRL measurements when possible and should be obtained in a true midsagittal plane, with the genital tubercle and fetal spine longitudinally in view and the maximum length from cranium to caudal rump measured as a straight line 8 Mean sac diameter measurements are not recommended for estimating the due date.
Previous guidelines - register and last menstrual obstetric estimate calculated according to calculate delivery date today. If possible or type of pregnancy in. Such as acog ultrasound dating of the due date today. Since , ultrasound dating guidelines - find a date by ultrasound date ap If labor should be warranted based on. Dec 05, Postterm pregnancy refers to a pregnancy that has reached or extended beyond 42 0/7 weeks of gestation from the last menstrual period (LMP), whereas a late-term pregnancy is defined as one that has reached between 41 0/7 weeks and 41 6/7 weeks of gestation (1). In , the overall incidence of postterm pregnancy in the United States was (2). Introduction. Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. The use of X-ray, ultrasonography, CT, nuclear medicine, and MRI has become so ingrained in the culture of medicine, and their applications are so diverse, that women with recognized or unrecognized pregnancy are likely to be evaluated with any one of these modalities 1.
Dating changes for smaller discrepancies are appropriate based on how early in the first trimester the ultrasound examination was performed and clinical assessment of the reliability of the LMP date Table 1. For example, for a day-5 embryo, the EDD would be days from the embryo replacement date. The use of gadolinium contrast with MRI should be limited; it may be used as a contrast agent in a pregnant woman only if it significantly improves diagnostic performance and is expected to improve fetal or maternal outcome.
Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions.
The use of X-ray, ultrasonography, CT, nuclear medicine, and MRI has become so ingrained in the culture of medicine, and their applications are so diverse, that women with recognized or unrecognized pregnancy are likely to be evaluated with any one of these modalities 1. This document reviews the available literature on diagnostic imaging in pregnancy and lactation. Obstetrician- gynecologists and other health care providers caring for pregnant and breastfeeding women in need of diagnostic imaging should weigh the risks of exposure to radiation and contrast agents with the risk of nondiagnosis and worsening of disease.
Planning and coordination with a radiologist often is helpful in modifying technique so as to decrease total radiation dose when ionizing radiation studies are indicated Table 1. Ultrasound imaging should be performed efficiently and only when clinically indicated to minimize fetal exposure risk using the keeping acoustic output levels As Low As Reasonably Achievable commonly known as ALARA principle.
Ultrasonography involves the use of sound waves and is not a form of ionizing radiation. There have been no reports of documented adverse fetal effects for diagnostic ultrasonography procedures, including duplex Doppler imaging. The U. However, it is highly unlikely that any sustained temperature elevation will occur at any single fetal anatomic site 3.
The risk of temperature elevation is lowest with B-mode imaging and is higher with color Doppler and spectral Doppler applications 4. Ultrasound machines are configured differently for different indications. Those configured for use in obstetrics do not produce the higher temperatures delivered by machines using nonobstetric transducers and settings. Similarly, although color Doppler in particular has the highest potential to raise tissue temperature, when used appropriately for obstetric indications, it does not produce changes that would risk the health of the pregnancy.
However, the potential for risk shows that ultrasonography should be used prudently and only when its use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient 5. When used in this manner and with machines that are configured correctly, ultrasonography does not pose a risk to the fetus or the pregnancy.
The principal advantage of MRI over ultrasonography and computed tomography is the ability to image deep soft tissue structures in a manner that is not operator dependent and does not use ionizing radiation.
There are no precautions or contraindications specific to the pregnant woman. Magnetic resonance imaging is similar to ultrasonography in the diagnosis of appendicitis, but when MRI is readily available, it is preferred because of its lower rates of nonvisualization 6. Although there are theoretical concerns for the fetus, including teratogenesis, tissue heating, and acoustic damage, there exists no evidence of actual harm.
Antenatal Care: Confirming and Dating Pregnancy – Obstetrics - Lecturio
With regard to teratogenesis, there are no published human studies documenting harm, and the preponderance of animal studies do not demonstrate risk 1. Finally, available studies in humans have documented no acoustic injuries to fetuses during prenatal MRI 1. In considering available data and risk of teratogenicity, the American College of Radiology concludes that no special consideration is recommended for the first versus any other trimester in pregnancy 8. However, there are diagnostic situations in which contrast enhancement is of benefit.
Two types of MRI contrast are available: 1 gadolinium-based agents and 2 superparamagnetic iron oxide particles. Gadolinium-based agents are useful in imaging of the nervous system because they cross the blood-brain barrier when this barrier has been disrupted, such as in the presence of a tumor, abscess, or demyelination 9. Although gadolinium-based contrast can help define tissue margins and invasion in the setting of placental implantation abnormalities, noncontrast MRI still can provide useful diagnostic information regarding placental implantation and is sufficient in most cases 7.
Even though it can increase the specificity of MRI, the use of gadolinium-based contrast enhancement during pregnancy is controversial. Uncertainty surrounds the risk of possible fetal effects because gadolinium is water soluble and can cross the placenta into the fetal circulation and amniotic fluid.
Free gadolinium is toxic and, therefore, is only administered in a chelated bound form. In animal studies, gadolinium agents have been found to be teratogenic at high and repeated doses 1presumably because this allows for gadolinium to dissociate from the chelation agent. In humans, the principal concern with gadolinium-based agents is that the duration of fetal exposure is not known because the contrast present in the amniotic fluid is swallowed by the fetus and reenters the fetal circulation.
The longer gadolinium-based products remain in the amniotic fluid, the greater the potential for dissociation from the chelate and, thus, the risk of causing harm to the fetus 8. The only prospective study evaluating the effect of antepartum gadolinium administration reported no adverse perinatal or neonatal outcomes among 26 pregnant women who received gadolinium in the first trimester More recently, a large retrospective study evaluated the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy This study interrogated a universal health care data-base in the province of Ontario, Canada to identify all births of more than 20 weeks of gestation, from to The risk also was not significantly higher for congenital anomalies, neoplasm, or vision or hearing loss.
Limitations of the study assessing the effect of gadolinium during pregnancy include using a control group who did not undergo MRI rather than patients who underwent MRI without gadolinium and the rarity of detecting rheumatologic, inflammatory, or infiltrative skin conditions Given these findings, as well as ongoing theoretical concerns and animal data, gadolinium use should be limited to situations in which the benefits clearly outweigh the possible risks 8 To date, there have been no animal or human fetal studies to evaluate the safety of superparamagnetic iron oxide contrast, and there is no information on its use during pregnancy or lactation.
Therefore, if contrast is to be used, gadolinium is recommended. The water solubility of gadolinium-based agents limits their excretion into breast milk. Less than 0.
Sep 02, Last ated September 29, at a.m. EST. Growing evidence suggests that pregnant women with COVID appear to be at increased risk of mechanical ventilation and ICU admission compared to their notruthexchange-sow.comegnant peers (Ellington MMWR , Collin , Delahoy MMWR , Panagiotakopoulos MMWR ).However, the data have several key limitations as noted in ACOG.
Although theoretically any unchelated gadolinium excreted into breast milk could reach the infant, there have been no reports of harm. Therefore, breastfeeding should not be interrupted after gadolinium administration 13 Commonly used for the evaluation of significant medical problems or trauma, X-ray procedures are indicated during pregnancy or may occur inadvertently before the diagnosis of pregnancy. Specifically, these data indicate an elevated risk of ICU admissions and mechanical ventilation.
No increase in the rate of mortality has been noted. Importantly, analyses so far are limited by a large amount of missing data and the fact that many reports do not include an appropriate notruthexchange-sow.comegnant comparative control group. Although these data from the CDC suggest an increase in risk of severe outcomes in pregnant women with SARS-CoV-2 infection, the absolute risk is still substantially lower than that of pandemic H1N1 influenza infection during pregnancy. Clinicians should counsel pregnant women and those contemplating pregnancy about the potential risk of COVID, and measures to prevent infection with SARS-CoV-2 should be emphasized for pregnant women and their families.
Pregnant individuals are encouraged to take all available precautions to avoid exposure to COVID and optimize health including:. When counseling pregnant individuals about COVID, it is important to acknowledge that these are unsettling times see FAQ How can I help my pregnant and postpartum patients manage stress, anxiety, and depression?
Although there are cases of reported vertical transmission of SARS-CoV-2, currently available data indicate that vertical transmission appears to be uncommon. It is unclear if these outcomes are directly due to SARS-CoV-2 infection or an indirect effect that results from severe maternal illness or iatrogenic intervention. Further, in a recently published report from the PRIORITY study, among initial infants enrolled, no difference in adverse outcomes, including preterm birth, NICU admission, and respiratory disease, were found between those born to mothers testing positive for SARS-CoV-2 and those born to mothers testing negative.
More data are needed to understand the possible association between SARS-CoV-2 infection and delivery timing, placental function, and neonatal outcomes. ACOG continues to monitor the emerging literature on these topics. Pregnant patients should follow the same recommendations as the general population as outlined by the CDC with regard to wearing a mask or a cloth facial covering.
ACOG recommends all individuals older than two years of age wear a mask or cloth face covering in public and when around people outside of the household, especially in settings where other social distancing measures are not feasible.
In particular, all persons entering a health care facility should wear a cloth face covering or facemask for the duration of their visit. Patients also should adhere to respiratory hygiene, cough etiquette, and hand hygiene and follow triage procedures throughout the duration of the visit.
The cloth facial coverings recommended are not surgical masks or N95 respirators. Surgical masks and N95 respirators are critical PPE supplies that must continue to be reserved for health care workers and other medical first responders, as recommended by current CDC guidance. Consistent with recommendations for the general population, masks should be worn when feasible.
However, in the setting of second stage of labor, pushing while wearing a facemask may be difficult and forceful exhalation may significantly reduce the effectiveness of a mask in preventing the spread of the virus by respiratory droplets. This situation further underscores the need for all health care personnel to use appropriate PPE while caring for a person with suspected or confirmed COVID Even in the setting of COVID, delayed pushing is not recommended as a strategy to avoid forced exhalation due to the adverse maternal outcomes associated with delayed pushing Committee Opinion No.
The risk of intimate partner violence is increased in the context of recommendations to shelter in place, physical distancing, financial hardships, and potential isolation and quarantine. The severity of intimate partner violence may escalate during pregnancy or the postpartum period. ACOG recommends screening all patients for intimate partner violence at periodic intervals throughout obstetric care at the first prenatal visit, at least once per trimester, and at the postpartum checkup Guidelines for Perinatal Care, 8th edition ; Committee Opinion Screening all patients multiple times is important because some women do not or cannot disclose abuse each time they are asked.
Unfortunately, screening for intimate partner violence by telehealth may not allow women the privacy or safety needed to disclose abuse. In addition to possibly screening during prenatal telehealth appointments, screening is important to perform during in-person appointments and at hospital admission in a private and safe setting with the patient alone and not in the presence of a partner, friends, family, or caregiver.
Obstetrician-gynecologists and other obstetric care professionals should proactively identify local resources and be prepared to offer or provide referrals for social work services, mental health care, or additional resources for patients who disclose intimate partner violence.
It may be necessary to provide these services or other enhanced resources by phone, electronically, or by telehealth where possible. Additional key resources include:. Perinatal mood and anxiety disorders are among the most common complications that occur in pregnancy or in the first 12 months after delivery.
Especially during this challenging time, obstetrician-gynecologists and other maternal health care professionals should screen all pregnant individuals at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool Committee Opinion Even if an individual is screened during pregnancy, additional screening also should occur during the postpartum period Committee Opinion Obstetrician-gynecologists and other maternal health care professionals should reassure patients that even during this time, there are effective treatment and support options.
If you are concerned that your patient may be at imminent risk of harm to self or others, refer them to emergency services for further evaluation.
Modifications to visitation policies should be made on an individual facility level and based on community spread, local and state recommendations or regulations, and infection control and space considerations eg, whether postpartum recovery rooms are individual or shared, while adhering to appropriate social distancing.
The visitor policy should not be a barrier to an individual receiving medically-indicated in-person care. Visitors should be screened for symptoms of acute respiratory illness and should not be allowed entry if fever or respiratory symptoms are present; in those instances, a different, asymptomatic visitor can be allowed to provide support. Hospitals may consider routinely evaluating visitors for symptoms. Use of alternative mechanisms for patient and visitor interactions, such as video-call applications, can be encouraged for any additional support persons.
The Centers for Disease Control and Prevention CDC provides additional suggested guidance for managing visitors in inpatient obstetric health care settings. When counseling patients about any modified visitation policies, obstetrician-gynecologists and other obstetric care professionals should acknowledge the importance of support persons and also communicate that any policies that temporarily limit visitors or support persons are being implemented for the safety of the patient, her newborn, and the community.
Labor, delivery, and postpartum support may be especially important to improve outcomes for individuals from communities traditionally underserved or mistreated within the health care system.
In considering visitation policies, institutions should be mindful of how restrictions might differentially and negatively affect these communities, which in many areas are also disproportionately affected by COVID In addition, facilities may consider additional molecular eg, PCR by nasopharyngeal swab testing strategies, such as universal testing because there is the potential for asymptomatic patients to present to labor and delivery units, particularly in high prevalence areas.
Key factors in considering expanded or universal diagnostic PCR testing in labor and delivery units include:. Pregnancy is a hypercoagulable state, and women who are pregnant or in the postpartum period have a fourfold to fivefold increased risk of thromboembolism compared with notruthexchange-sow.comegnant women Practice BulletinThromboembolism in Pregnancy.
Although not yet known, it is possible that pregnancy and COVID infection may be additive for risk of thrombosis. Although evidence is lacking for or against thromboprophylaxis for pregnant and postpartum patients with suspected or confirmed COVID, it is reasonable to consider anticoagulation treatment for these patients, particularly if they have severe or critical disease. Additional resources: American Society of Hematology.
COVID resources on coagulation and anticoagulation International Society on Thrombosis and Haemostasis These links are for resource purposes only and should not be considered developed or endorsed by the American College of Obstetricians and Gynecologists. Yet, there is no available data that stratifies this risk by gestational age, wearing a facemask, capacity to screen for SARS CoV-2 infection, or the effect of the level of community prevalence of SARS-CoV-2 infection.
Importantly, pregnant individuals may continue to work until they give birth. For many women, not working is not feasible. If a pregnant individual decides to work throughout pregnancy, this decision should be supported, and accommodations should be made.
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ACOG recommends that:. Further, every possible protection from exposure to COVID eg, masks, gloves, remote working, etc should be advocated for pregnant women in the work place.
Alternate prenatal care delivery approaches have been proposed as a strategy in the effort to control the spread of COVID among patients, caregivers, and staff. Although evidence is limited regarding the safety and efficacy of these approaches, ACOG recognizes the need to implement innovative strategies during this rapidly evolving public health emergency, with consideration of differences in care settings and population risks.
Emerging evidence suggest that with the appropriate precautions, in-person obstetric health care can be safely performed and is not likely to be an important risk factor for infection Reale Any decision to modify prenatal care delivery should be made at the local and individual level.
Some examples of approaches to modifying prenatal care that may be considered are listed below.
However, modifying or reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal care approaches and schedules should resume when this risk subsides. Plans for modified care are best made at the local level with consideration of patient populations and available resources.
Yes, and ACOG encourages practices and facilities that do not yet have the infrastructure to offer telehealth to begin strategizing how telehealth could be integrated into their services as appropriate. Importantly, the ability to access telemedicine may vary by patient resources and some assessment of this-although often challenging in times of crisis-will be necessary to ensure equitable care.
As part of the COVID emergency response, several new federal telehealth allowances have been made. The Department of Health and Human Services Office for Civil Rights has announced that it will exercise enforcement discretion and waive penalties for HIPAA violations against health care clinicians who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID nationwide public health emergency.
The Drug Enforcement Administration has released guidance allowing health care clinicians registered by the administration to issue prescriptions for controlled substances without an in-person medical evaluation for the duration of the public health emergency see specific guidelines here. Health care clinicians can also consider an approach eg.
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Patients should be instructed to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection eg, cough, sore throat, fever on the day they are scheduled to be seen.
This can be done through phone calls before appointments asking about recent travel, potential exposure, and symptoms. Proactive communication to all patients ie, via email, text, recorded phone calls advising individuals with possible exposure to or symptoms of COVID to call the office first also may be considered.
Additionally, health care clinicians should confirm whether a person is currently undergoing testing for COVID If, after screening, the patient reports symptoms of or exposure to a person with COVID, that patient should be instructed not to come to the health care facility for their appointment and health care clinicians should contact the local or state health department to report the patient as a possible person under investigation PUI.
Antenatal fetal surveillance and ultrasonography Practice Bulletin should continue as medically indicated when possible. It may be appropriate to postpone or cancel some testing or examinations if the risk of exposure and infection within the community outweighs the benefit of testing. However, this should be a decision made at the local practice or facility level, balancing the risks and benefits of decreased exposure, completing the test, and site capacity.
As with other components of prenatal care, reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal antenatal testing or ultrasonography scheduling should resume when this risk subsides. Any modifications made to care should be relayed to patients with a discussion of the altered balance of risks and -benefits of coming to the office for testing or ultrasonography in the setting of a global pandemic, and should be documented in the medical record.
During acute illness, fetal management should be similar to that provided to any critically ill pregnant person. Continuous fetal monitoring in the setting of severe illness should be considered only after fetal viability, when delivery would not compromise maternal health or as another noninvasive measure of maternal status. In the setting of a mild infection, management similar to that for a patient recovering from influenza is reasonable.
It should be emphasized that patients can decompensate after several days of apparently mild illness, and thus should be instructed to call or be seen for care if symptoms, particularly shortness of breath, worsen.
Should new literature indicate any need for additional antenatal fetal surveillance for pregnant patients with suspected or confirmed COVID, ACOG will ate our recommendations accordingly. As such, and because of the prevalence of low-dose aspirin use during pregnancy and the importance of low-dose aspirin in preeclampsia prevention Committee OpinionPractice Bulletinlow-dose aspirin should continue to be offered to pregnant and postpartum women as medically indicated.
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For patients with suspected or confirmed COVID for whom low-dose aspirin would be indicated, modifications to care may be individualized. Patients concerned that delivering in a hospital or accredited birth center setting will increase their risk of exposure to COVID should be assured that hospitals and accredited birth centers continue to be safe with strict infection control procedures.
It should be noted that it may be necessary to provide these services or other enhanced resources by phone or electronically where possible. If telehealth visits are anticipated, patients should be provided with any necessary equipment eg, blood pressure cuffs if available and as appropriate.
Maternal immunizations continue to be an essential component of prenatal care during the COVID pandemic. Adhering to the recommended timing of maternal immunization as much as possible is encouraged to maximize maternal and fetal benefits. Modified prenatal care schedules during COVID may make it disproportionately more difficult for some to receive preventive care such as maternal immunizations.
This reality underscores the importance of clinicians integrating social determinants of health screening into practice, and maximizing and facilitating referrals to social services Committee Opinion Similar to other infectious diseases, if a postpartum individual has suspected or confirmed COVID and did not receive indicated immunizations prior to e.
However, based on recent data supporting the use of corticosteroids in severely ill patients in the treatment of COVID, it does not appear that the administration of corticosteroids leads to maternal harm. Therefore, ACOG now recommends offering antenatal corticosteroids, as indicated, for fetal benefit, as outlined in Committee Opinionincluding during the late preterm period.
A preliminary published analysis from a large, multicenter, randomized, open-label trial for hospitalized patients in the United Kingdom demonstrated that patients who were randomized to receive dexamethasone 6mg once daily; oral or IV had a reduced rate of mortality compared to those who received standard of care NEJM In the dexamethasone group, the incidence of death was lower than that in the standard care group among patients requiring mechanical ventilation Therefore, for the general population, the NIH now recommends using dexamethasone at a dose of 6 mg per day for up to 10 days in patients with COVID who are mechanically ventilated and in patients with COVID who require supplemental oxygen but who are not mechanically ventilated.
Although these recommendations are not specific to pregnant individuals, ACOG recommends that dexamethasone be used for pregnant women with COVID who are receiving supplemental oxygen or are mechanically ventilated, and that dexamethasone should not be withheld for treatment of COVID due to pregnancy status.
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When a pregnant patient with suspected or confirmed COVID is admitted and birth is anticipated, the obstetric, pediatric or family medicine, and anesthesia teams should be notified in order to facilitate care.
For women with suspected or confirmed COVID early in pregnancy who recover, no alteration to the usual timing of delivery is indicated. For women with suspected or confirmed COVID in the third trimester who recover, it is reasonable to attempt to postpone delivery if no other medical indications arise until a negative testing result is obtained or quarantine status is lifted in an attempt to avoid transmission to the neonate. Currently, based on very limited data based on primarily cesarean deliveries, there does not appear to be a risk of vertical transmission via the transplacental route.
Additionally, based on limited data, outcomes for individuals appear to be similar between pregnant and notruthexchange-sow.comegnant patients. Cesarean delivery should therefore be based on obstetric fetal or maternal indications and not COVID status alone.
Inductions of labor and cesarean deliveries should continue to be performed as indicated. Decisions on how to schedule these procedures in the time of the COVID pandemic are best made at the local facility and systems level, with input from obstetric care professionals and based on health care personnel availability, geography, access to readily available local resources, and coordination with other centers.
For information on elective procedures, please see How can elective procedures be managed to optimize personnel and resources?
To help you educate your patients and provide the latest care, this topic center provides a broad range of COVID resources, including clinical guidance, educational materials, and more. For healthy pregnant women, occasional air travel is almost always safe. Most airlines allow pregnant women to fly domestically until about 36 weeks of pregnancy. Your ob-gyn or other health care professional can provide proof of your due date if you need it. If you are planning an international flight, the cut-off for traveling may be earlier. A pelvic examination supported by good menstrual records in the first trimester has been reported to be a reliable method for dating of pregnancy . Doppler Ultrasonography The fetal heart can be heard using Doppler ultrasound by 10 to 12 weeks in most patients .
Practitioners should follow usual clinical indications for operative vaginal delivery, in the setting of appropriate personal protective equipment Practice Bulletin on Operative Vaginal Delivery. Yes, delayed cord clamping is still appropriate in the setting of appropriate clinician personal protective equipment. Although some experts have recommended against delayed cord clamping, the evidence is based on opinion ; a single report later confirmed COVID transmission most likely occurred from the obstetric care clinician to the neonate.
Current evidence-based guidelines for delayed cord clamping should continue to be followed until emerging evidence suggests a change in practice. Respiratory diseases are typically not transmitted by the transfer of human cells. Currently, there are no reported cases of transmission of COVID by blood products FDA ; therefore, umbilical cord blood banking can continue to be managed according to clinical guidance Committee Opinionin the setting of appropriate clinician personal protective equipment.
A variety of circumstances may arise during the process of labor and delivery that may preclude adequate cord blood collection. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation Committee Opinion Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor Committee Opinion No.
The presence of doulas during the COVID pandemic should be considered in the context of the institutional visitor policy. If doulas are considered by the facility to be health care personnel, they should adhere to infection prevention and control recommendations, including the correct and consistent use of proper personal protective equipment.
Labor, delivery, and postpartum support may be especially important to improve outcomes for individuals from communities traditionally underserved or mistreated or harmed within the health care system. With insufficient information currently available regarding the physiologic safety of inhaled nitrous oxide in individuals with suspected or confirmed COVID, labor and delivery units may consider suspending use of nitrous oxide for individuals with suspected or confirmed COVID or individuals with unconfirmed COVID negative status.
For patients with a diagnostic test for COVID confirmed negative, nitrous oxide may continue to be offered as an option for analgesia. Oxygen should continue to be considered if maternal hypoxia is noted Practice Bulletin Based on limited data, high-flow oxygen use is not considered an aerosol-generating procedure CDC.
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Still, there is insufficient evidence about the cleaning and filtering when using oxygen. As such, facilities should consider suspending routine use of intrapartum oxygen for indications where benefits of use are not well-established eg. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID and whether the patient should be tested.
However, other causes of intrapartum fever should not be overlooked. Data regarding COVID in pregnancy are limited; according to current information, presenting signs and symptoms are expected to be similar to those for non-pregnant patients, including the presence of fever. Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID infections. As part of evaluation, clinicians are strongly encouraged to test for other causes of respiratory illness and peripartum fever.
Hemabate is associated with bronchospasm, such that its use is contraindicated in women with asthma Practice BulletinPostpartum Hemorrhage. Because of the possible additive effect of the increased risk of thrombosis from COVID infection and the hypercoagulative state of pregnancy, it may be prudent to consider this increased likelihood of clotting before administering TXA for postpartum hemorrhage.
American Society of Hematology. To limit the risk of inadvertent exposure and infection, it may be appropriate to expedite discharge when both the mother and the infant are healthy Committee Opinion