POST DELIVERY/NEONATAL MANAGEMENT OF WOMEN WITH COVID-19
INFECTION
Delayed clamping of the umbilical cord remains a controversial issue.
ISUOG and FIGO guidelines both recommend prompt clamping of the cord and
transfer of the neonate to the resuscitation area for evaluation by the
paediatric team.8, 9 In contrast and in recognition of
the lack of evidence to suggest otherwise, the RCOG continue to
recommend delayed cord clamping.7 According to WHO,
delayed cord clamping is highly unlikely to increase the risk of
vertical transmission of pathogens even in the context of maternal
infection.26 Furthermore, to date, no positive RT-PCR
results have been found in the amniotic fluid, placenta or cord blood of
the studied population. In the UKOSS cohort, 6 infants born to 244 women
hospitalised with COVID-19 infection tested positive for SARS-COV-2 RNA,
with only one infant requiring admission to the neonatal intensive care
unit. Another systematic review including 256 infants born to women with
COVID-19 infection reported only 4 who were RT-PCR positive for
SARS-COV-2 RNA within the first 36 hours of birth.11Again, samples from their cord blood, placenta and amniotic fluid were
all negative and all 4 infants had an uncomplicated recovery. Therefore,
there is no conclusive evidence at present of fetal infection via
intrauterine vertical transmission. Considering the well-known clinical
benefits to the neonate of delayed cord clamping, there is some concern
amongst experts that recommending otherwise in women with COVID-19 in
the absence of sufficient evidence could be harmful.
There is currently limited evidence regarding the safety of
breastfeeding and the need for mother-baby separation. In view of this,
all guidelines advise against universal isolation of neonates born to
mothers with COVID-19 infection and that it may only be appropriate if
the mother is critically ill. An alternative to separation suggested by
FIGO and ISUOG guidelines is ‘co-rooming’ where the baby’s cot is kept
at least 2 metres from the mothers bed.8, 9 The main
concern of breastfeeding is the risk of transmitting SARS-COV-2 from the
mother to the baby via respiratory droplets rather than the breast milk
itself. All samples of breast milk have so far tested negative for
SARS-COV-2.11 The RCOG, ISUOG and FIGO guidelines all
advise that those who wish to breast feed, should the maternal condition
allow, continue to do so. However, precautions should be taken such as
hand washing and the use of a surgical mask by the mother to prevent
viral spread to the baby.7-9
The highest risk of venous thromboembolism (VTE) is during the first six
weeks of the postnatal period with a 12-fold increase compared to the
non-pregnant, non-postpartum population.27Furthermore, emerging evidence shows that COVID-19 is associated with
significant coagulopathy namely disseminated intravascular coagulation
leading to VTE.28 Although the risk remains highest in
those who are critically unwell, representing only about 5 percent of
the population with COVID-19, the impact on VTE risk in those with mild
to moderate disease remains unknown.28 Thus, the RCOG
recommend that, following birth, all women with COVID-19 infection
should be discharged with at least 10 days of treatment with low
molecular weight heparin or longer should additional risk factors be
present.7