Classification processing to the pregnant women according to the epidemiological history and clinical symptoms
The proportion of COVID-19 patients without fever is higher than that of SARS-CoV (1%) and MERS-CoV (2%) infection112.Zumla A, Hui DS, Perlman S. Middle East respiratory syndrome. Lancet 2015;386:995-1007., so if the definition of surveillance cases focuses on detecting fever, patients without fever may be missed223.World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. January 28, 2020 (https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf). Therefore, epidemiological history is particularly important in screening COVID-19 patient. We classify pregnant women into three groups according to the history of epidemiology and clinical symptoms.
  1. First group: Routine obstetrical examination for normal pregnant women. Pregnant women who have no history of epidemiological exposure and no clinical symptoms will undergo routine obstetrical examination. If there are no pregnancy complications, antenatal examination can be appropriately reduced in frequency; high-risk pregnant women with pregnancy complications should appropriately increase the frequency of obstetrical examinations. Pregnant women can self-monitor blood pressure, blood sugar, weight, fetal movement at home. Free online consultation and guidance was used for pregnant women.
  2. Second group: Pregnant woman with a history of epidemiological exposure but without symptoms such as fever or respiratory symptoms should be isolated at home and under medical observation. It is recommended that home isolation of the pregnant women and monitoring of maternal health should be maintained for at least 14 days in accordance with the ”guidelines for the Prevention and Control of novel coronavirus’s pneumonia at Home isolation Medical observation and infection Prevention and Control (trial)”334.National Health Commission of the People’s Republic of China. Guidelines for the Prevention and Control of COVID-19 in Home isolation Medical observation (trial) [EB/OL]. [2020-02-18]. (http://www.nhc.gov.cn/yzygj/s7659/202002/cf80b05048584f8da9b4a54871c44b26.shtml.). In addition to self-monitoring of body temperature, fever and other symptoms, pregnant women can also self-monitor their blood pressure, blood sugar, weight, fetal movement at home and have free online consultation from doctor. For pregnant women approaching the due date, relevant laboratory examination, chest CT test and nucleic acid test can be carried at outpatient obstetrical department.
  3. Third group: Pregnant women with a history of epidemiological contact and with fever or respiratory symptoms should go to the fever clinic. They should be considered as suspected cases and isolated in a single room. Medical staff and patients should take protective measures and the multidisciplinary consultation should be conducted simultaneously. Blood routine examination, chest CT examination and the COVID-19 nucleic acid test should be finished in time. CT examination has important reference value for the evaluation of COVID-19 ’s pregnant woman’s condition, so we should fully communicate with pregnant women of the necessity of chest CT examination, sign the informed consent form, and take necessary abdominal protective measures during CT scan. The suspected cases should be reported directly through the network within 2 hours, and they should be transferred to the designated hospital immediately on the premise of ensuring the safety of transportation.