These infection prevention and control considerations are for healthcare facilities providing obstetric care for pregnant patients with confirmed coronavirus disease (COVID-19) or pregnant persons under investigation (PUI) in inpatient obstetric healthcare settings including obstetrical triage, labor and delivery, recovery and inpatient postpartum settings.
This information is intended to aid hospitals and clinicians in applying
broader CDC interim guidance on infection control (Interim Infection Prevention and Control
Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19)
or Persons Under Investigation for COVID-19 in Healthcare Settings).
Since maternity and newborn care units vary in physical configuration,
each facility should consider their appropriate space and staffing needs to
prevent transmission of the virus that causes COVID-19. These considerations
include appropriate isolation of pregnant patients who have confirmed COVID-19
or are PUIs; basic and refresher training for all healthcare personnel on those
units to include correct adherence to infection control practices and personal
protective equipment (PPE) use and handling; sufficient and appropriate PPE
supplies positioned at all points of care; and processes to protect newborns
from risk of COVID-19.
These considerations are based upon the limited evidence available to
date about transmission of the virus that causes COVID-19, and knowledge of
other viruses that cause severe respiratory illness including influenza, severe
acute respiratory syndrome coronavirus (SARS-CoV), and Middle East Respiratory
Syndrome coronavirus (MERS-CoV). The approaches outlined below are
intentionally cautious until additional data become available to refine
recommendations for prevention of person-to-person transmission in inpatient
obstetric care settings.
Prehospital Considerations
- Pregnant patients who have confirmed COVID-19 or
who are PUIs should notify the obstetric unit prior to arrival so the
facility can make appropriate infection control preparations (e.g.,
identifying the most appropriate room for labor and delivery, ensuring
infection prevention and control supplies and PPE are correctly
positioned, informing all healthcare personnel who will be involved in the
patient’s care of infection control expectations) before the patient’s
arrival.
- If a pregnant patient who has confirmed COVID-19
or is a PUI is arriving via transport by emergency medical services, the
driver should contact the receiving emergency department or healthcare
facility and follow previously agreed-upon local or regional transport
protocols. For more information refer to the Interim Guidance for Emergency Medical Services
(EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19
in the United States.
- Healthcare providers should promptly notify
infection control personnel at their facility of the anticipated arrival
of a pregnant patient who has confirmed COVID-19 or is a PUI.
During Hospitalization
- Healthcare facilities should ensure recommended
infection control practices for hospitalized pregnant patients who have
confirmed COVID-19 or are PUIs are consistent with Interim Infection Prevention and Control
Recommendations for Patients with Confirmed Coronavirus Disease 2019
(COVID-19) or Persons Under Investigation for COVID-19 in Healthcare
Settings.
- All healthcare facilities that provide obstetric
care must ensure that their personnel are correctly trained and capable of
implementing recommended infection control interventions. Individual
healthcare personnel should ensure they understand and can adhere to
infection control requirements.
- Healthcare facilities should follow the above infection control guidance on managing visitor access, including essential support
persons for women in labor (e.g., spouse, partner).
- Infants born to mothers with confirmed COVID-19
should be considered PUIs. As such, infants should be isolated according
to the Infection Prevention and Control Guidance for
PUIs.
Mother/Baby Contact
- It is unknown whether newborns with COVID-19 are
at increased risk for severe complications. Transmission after birth via
contact with infectious respiratory secretions is a concern. To reduce the
risk of transmission of the virus that causes COVID-19 from the
mother to the newborn, facilities should consider temporarily separating
(e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI
from her baby until the mother’s transmission-based precautions are
discontinued, as described in the Interim Considerations for Disposition of
Hospitalized Patients with COVID-19. See the considerations below for temporary
separation:
- The risks and benefits of temporary separation
of the mother from her baby should be discussed with the mother by the
healthcare team.
- A separate isolation room should be available
for the infant while they remain a PUI. Healthcare facilities should
consider limiting visitors, with the exception of a healthy parent or
caregiver. Visitors should be instructed to wear appropriate PPE,
including gown, gloves, face mask, and eye protection. If another healthy
family or staff member is present to provide care (e.g., diapering,
bathing) and feeding for the newborn, they should use appropriate PPE. For
healthy family members, appropriate PPE includes gown, gloves, face mask,
and eye protection. For healthcare personnel, recommendations for
appropriate PPE are outlined in the Infection Prevention and Control Recommendations.
- The decision to discontinue temporary separation
of the mother from her baby Considerations to discontinue temporary
separation are the same as those to discontinue transmission-based
precautions for hospitalized patients with COVID-19. Please see Interim Considerations for Disposition of
Hospitalized Patients with COVID-19.
- If colocation (sometimes referred to as “rooming
in”) of the newborn with his/her ill mother in the same hospital room
occurs in accordance with the mother’s wishes or is unavoidable due to
facility limitations, facilities should consider implementing measures to
reduce exposure of the newborn to the virus that causes COVID-19.
- Consider using
engineering controls like physical barriers (e.g., a curtain between the
mother and newborn) and keeping the newborn ≥6 feet away from the ill
mother.
- If no other healthy
adult is present in the room to care for the newborn, a mother who has
confirmed COVID-19 or is a PUI should put on a facemask and practice
hand hygiene1 before each feeding or other close contact with her
newborn. The facemask should remain in place during contact with the
newborn. These practices should continue while the mother is
on transmission-based precautions in a healthcare facility.should
be made on a case-by-case basis in consultation with clinicians,
infection prevention and control specialists, and public health
officials. The decision should take into account disease severity,
illness signs and symptoms, and results of laboratory testing for the
virus that causes COVID-19, SARS-CoV-2.
Breastfeeding
- During temporary separation, mothers who intend
to breastfeed should be encouraged to express their breast milk to
establish and maintain milk supply. If possible, a dedicated breast pump
should be provided. Prior to expressing breast milk, mothers should practice
hand hygiene.1 After each pumping session, all parts that come into contact
with breast milk should be thoroughly washed and the entire pump should be
appropriately disinfected per the manufacturer’s instructions. This
expressed breast milk should be fed to the newborn by a healthy caregiver.
- If a mother and newborn do room-in and the mother
wishes to feed at the breast, she should put on a facemask and practice
hand hygiene before each feeding.
Hospital Discharge
- Discharge for postpartum women should follow
recommendations described in the Interim Considerations for Disposition of
Hospitalized Patients with COVID-19.
- For infants with pending testing results or who
test negative for the virus that causes COVID-19 upon hospital discharge,
caretakers should take steps to reduce the risk of transmission to the
infant, including following the Interim Guidance for Preventing Spread of
Coronavirus Disease 2019 (COVID-19) in Homes and Residential Communities.
Footnote:
1 Hand hygiene includes use of alcohol-based hand
sanitizer that contains 60% to 95% alcohol before and after all patient
contact, contact with potentially infectious material, and before putting on
and upon removal of PPE, including gloves. Hand hygiene can also be performed
by washing with soap and water for at least 20 seconds. If hands are visibly
soiled, use soap and water before returning to alcohol-based hand sanitizer.
Additional resources:
- Evaluating and Reporting Persons Under
Investigation (PUI)
- Resources for Hospitals and Healthcare
Professionals Preparing for Patients with Suspected or Confirmed COVID-19
- Interim Infection Prevention and Control
Recommendations for Patients with Confirmed Coronavirus Disease 2019
(COVID-19) or Persons Under Investigation for COVID-19 in Healthcare
Settings
- World
Health Organization Interim Guidance on Clinical Management of Severe
Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection Is
Suspected
