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. 2016 Feb 24;31(4):358–364. doi: 10.1016/S1701-2163(16)34155-X

Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS)

Cynthia Maxwell 1, Alison McGeer 2, Kin Fan Young Tai 3, Mathew Sermer 4; MATERNAL FETAL MEDICINE COMMITTEE; INFECTIOUS DISEASE COMMITTEE
PMCID: PMC7129583  PMID: 19497157

Abstract

Objective

This document summarizes the limited experience of SARS in pregnancy and suggests guidelines for management.

Outcomes

Cases reported from Asia suggest that maternal and fetal outcomes are worsened by SARS during pregnancy.

Evidence

Medline was searched for relevant articles published in English from 2000 to 2007. Case reports were reviewed and expert opinion sought.

Values

Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.

Sponsors

The Society of Obstetricians and Gynaecologists of Canada.

Recommendations

  • 1.

    All hospitals should have infection control systems in place to ensure that alerts regarding changes in exposure risk factors for SARS or other potentially serious communicable diseases are conveyed promptly to clinical units, including the labour and delivery unit. (III-C)

  • 2.

    At times of SARS outbreaks, all pregnant patients being assessed or admitted to the hospital should be screened for symptoms of and risk factors for SARS. (III-C)

  • 3.

    Upon arrival in the labour triage unit, pregnant patients with suspected and probable SARS should be placed in a negative pressure isolation room with at least 6 air exchanges per hour. All labour and delivery units caring for suspected and probable SARS should have available at least one room in which patients can safely labour and deliver while in need of airborne isolation. (III-C)

  • 4.

    If possible, labour and delivery (including operative delivery or Caesarean section) should be managed in a designated negative pressure isolation room, by designated personnel with specialized infection control preparation and protective gear. (III-C)

  • 5.

    Either regional or general anaesthesia may be appropriate for delivery of patients with SARS. (III-C)

  • 6.

    Neonates of mothers with SARS should be isolated in a designated unit until the infant has been well for 10 days, or until the mother’s period of isolation is complete. The mother should not breastfeed during this period. (III-C)

  • 7.

    A multidisciplinary team, consisting of obstetricians, nurses, pediatricians, infection control specialists, respiratory therapists, and anaesthesiologists, should be identified in each unit and be responsible for the unit organization and implementation of SARS management protocols. (III-C)

  • 8.

    Staff caring for pregnant SARS patients should not care for other pregnant patients. Staff caring for pregnant SARS patients should be actively monitored for fever and other symptoms of SARS. Such individuals should not work in the presence of any SARS symptoms within 10 days of exposure to a SARS patient. (III-C)

  • 9.

    All health care personnel, trainees, and support staff should be trained in infection control management and containment to prevent spread of the SARS virus. (III-A)

  • 10.

    Regional health authorities in conjunction with hospital staff should consider designating specific facilities or health care units, including primary, secondary, or tertiary health care centres, to care for patients with SARS or similar illnesses. (III-A)

Key Words: Severe acute respiratory syndrome (SARS), pregnancy, perinatal morbidity, perinatal mortality, maternal morbidity, maternal mortality, acute respiratory distress syndrome (ARDS), neonatal care

Footnotes

This Clinical Practice Guideline has been prepared by the Maternal Fetal Medicine Committee, reviewed by the Infectious Disease Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.

Disclosure statements have been received from all members of the committees.

This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.

Contributor Information

MATERNAL FETAL MEDICINE COMMITTEE:

Dan Farine, Melanie Basso, Marie-France Delisle, Lynda Hudon, Savas Menticoglou, William Mundle, and Annie Ouellet

INFECTIOUS DISEASE COMMITTEE:

Mark H. Yudin, Marc Boucher, Eliana Castillo, Beatrice Cormier, Andrée Gruslin, Deborah M. Money, Kellie Murphy, Caroline Paquet, Audrey Steenbeek, Nancy Van Eyk, Julie van Schalkwyk, and Thomas Wong

REFERENCES

  • 1.World Health Organization. WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS). Available at: http://www.who.int/csr/sars/en/index.html. Accessed May 20, 2004.
  • 2.Health Canada . September 2003. Canadian SARS numbers, 3.http://www.sars.gc.ca Available at: Accessed May 20, 2004. [Google Scholar]
  • 3.Ksiazek T.J., Erdman T., Goldsmith C.S., Zaki S.R., Peret T., Emery S., et al. A novel coronavirus associated with severe acute respiratory syndrome. N Eng J Med. 2003;348:1953–1966. doi: 10.1056/NEJMoa030781. [DOI] [PubMed] [Google Scholar]
  • 4.Drosten C., Gunther S., Preiser W., van der Werf S., Brodt H.R., Becker S., et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003;348:1697–16976. doi: 10.1056/NEJMoa030747. [DOI] [PubMed] [Google Scholar]
  • 5.Peiris J.S., Lai S.T., Poon L.L., Guan Y., Yam L.Y., Lim W., et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319–1325. doi: 10.1016/S0140-6736(03)13077-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Poutanen S.M., Low D.E., Henry B., Finkelstein S., Rose D., Green K., et al. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005. doi: 10.1056/NEJMoa030634. [DOI] [PubMed] [Google Scholar]
  • 7.Seto W.H., Tsang D., Yung R.W., Ching T.Y., Ng T.K., Ho M., et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome. Lancet. 2003;361:1519–1520. doi: 10.1016/S0140-6736(03)13168-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Yudin M.H., Steele D.M., Sgro M.D., Read S.E., Kopplin P., Gough K.A. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol. 2005;105:124–127. doi: 10.1097/01.AOG.0000151598.49129.de. [DOI] [PubMed] [Google Scholar]
  • 9.Lee N., Hui D., Wu A., Chan P., Cameron P., Joynt G.M., et al. N Engl J Med. 2003. A major outbreak of severe acute respiratory syndrome in Hong Kong; pp. 1986–1994. [DOI] [PubMed] [Google Scholar]
  • 10.Vu H.T., Leitmeyer K.C., Le D.H., Miller M.J., Nguyen Q.H., Uyeki T.M., et al. Clinical description of a completed outbreak of SARS in Vietnam, February–May 2003. Emerg Inf Dis. 2004;10:334–338. doi: 10.3201/eid1002.030761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Quah S.R., Hin-Peng L. Crisis prevention and management during SARS outbreak, Singapore. Emerg Inf Dis. 2004;10:364–368. doi: 10.3201/eid1002.030418. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.From the Centers for Disease Control and Prevention Update: outbreak of severe acute respiratory syndrome—worldwide, 2003. JAMA. 2003;289:1918–1920. doi: 10.1001/jama.289.15.1918. [DOI] [PubMed] [Google Scholar]
  • 13.Hsieh Y.H., Chen C.W., Hsu S.B. SARS outbreak, Taiwan, 2003. Emerg Inf Dis. 2004;10:201–206. doi: 10.3201/eid1002.030515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Health Canada . Management of severe acute respiratory sydrome (SARS) in adults: interim guidance for health care providers. Health Canada website; July 2, 2003. http://www.sars.gc.ca Available at: Accessed May 20, 2004. [Google Scholar]
  • 15.Booth C.M., Matukas L.M., Tomlinson G.A., Rachlis A.R., Rose D.B., Dwosh H.A., et al. Clinical features and short-term outcomes of 144 patients with SARS in the Greater Toronto Area. JAMA. 2003;289:2801–2809. doi: 10.1001/jama.289.21.JOC30885. [DOI] [PubMed] [Google Scholar]
  • 16.Fowler B.R., Lapinsky S.E., Hallett D., Detsky A.S., Sibbald W.J., Slutsky A.S., et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367–373. doi: 10.1001/jama.290.3.367. [DOI] [PubMed] [Google Scholar]
  • 17.Benedetti T.J., Valle R., Ledger W.J. Antepartum pneumonia in pregnancy. Obstet Gynecol. 1982;144:413–417. doi: 10.1016/0002-9378(82)90246-0. [DOI] [PubMed] [Google Scholar]
  • 18.Madinger N.E., Greenspoon J.S., Eilrodt A.G. Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome? Am J Obstet Gynecol. 1989;161:657–662. doi: 10.1016/0002-9378(89)90373-6. [DOI] [PubMed] [Google Scholar]
  • 19.Berkowitz K., LaSala A. Risk factors associated with the increasing prevalence of pneumonia during pregnancy. Am J Obstet Gynecol. 1990;163:981–985. doi: 10.1016/0002-9378(90)91109-p. [DOI] [PubMed] [Google Scholar]
  • 20.Visscher H.C., Visscher R.D. Indirect obstetric deaths in the state of Michigan 1960–1968. Am J Obstet Gynecol. 1971;109:1187–1196. doi: 10.1016/0002-9378(71)90664-8. [DOI] [PubMed] [Google Scholar]
  • 21.Finland M., Dublin T.D. Pneumococcal pneumonias complicating the pregnancy and puerperium. JAMA. 1983;250:1027–1032. [Google Scholar]
  • 22.Rigby F.B., Pastorek J.G. Pneumonia during pregnancy. Clin Obstet Gynecol. 1996;39:107–119. doi: 10.1097/00003081-199603000-00011. [DOI] [PubMed] [Google Scholar]
  • 23.Sargent I.L., Redman C. In: Medicine of the fetus and mother. Reece E.A., Hobbins J.C., Mahoney M.J., Petrie R.H., editors. JB Lippincott Company; Philadelphia: 1992. Immunobiologic adaptations of pregnancy; pp. 317–327. [Google Scholar]
  • 24.Nyhan D., Bredin C., Quigley C. Acute respiratory failure in pregnancy due to staphylococcal pneumonia. Ir Med J. 1983;76:320–321. [PubMed] [Google Scholar]
  • 25.Weinberger S., Weiss S., Cohen W., Weiss J., Johnson T.S. Pregnancy and the lung. Am Rev Resp Dis. 1980;121:559–581. doi: 10.1164/arrd.1980.121.3.559. [DOI] [PubMed] [Google Scholar]
  • 26.Leontic E. Respiratory disease in pregnancy. Med Clin North Am. 1977;61:111–128. doi: 10.1016/s0025-7125(16)31351-7. [DOI] [PubMed] [Google Scholar]
  • 27.McKinney P., Volkert P., Kaufman J. Fatal swine influenza pneumonia during late pregnancy. Arch Intern Med. 1990;150:213–215. [PubMed] [Google Scholar]
  • 28.Larsen J.W. Influenza and pregnancy. Clin Obstet Gynecol. 1982;25:599–603. doi: 10.1097/00003081-198209000-00017. [DOI] [PubMed] [Google Scholar]
  • 29.Eickhoff T.C., Sherman I.L., Serfling R.E. Observations on excess mortality associated with epidemic influenza. JAMA. 1961;176:776–782. doi: 10.1001/jama.1961.03040220024005. [DOI] [PubMed] [Google Scholar]
  • 30.Balducci J., Rodis J.F., Rosengren S., Vintzileos A., Spivey G., Vosseller C. Pregnancy outcome following first-trimester varicella infection. Obstet Gynecol. 1992;79:5–6. [PubMed] [Google Scholar]
  • 31.Pastuszak A.L., Levy M., Schick B., Zuber C., Feldkamp M., Gladstone J., et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Eng J Med. 1994;330:901–905. doi: 10.1056/NEJM199403313301305. [DOI] [PubMed] [Google Scholar]
  • 32.Wong S.F., Chow K.M., de Swiet M. Severe acute respiratory syndrome and pregnancy. BJOG. 2003;110:641–642. doi: 10.1046/j.1471-0528.2003.03008.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.So L.K.-Y., Lau A.C., Yam L.Y., Cheung T.M., Poon E., Yung R.W., et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet. 2003;361:1615–1617. doi: 10.1016/S0140-6736(03)13265-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Fujii T., Nakamura T., Iwamoto A. Current concepts in SARS treatment. J Infect Chemother. 2004;10:1–7. doi: 10.1007/s10156-003-0296-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Cinatl J., Morgenstern B., Bauer G., Chandra P., Rabenau H., Doerr H.W. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. Lancet. 2003;361:2045–2046. doi: 10.1016/S0140-6736(03)13615-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Knowles S.R., Ej Phillips, Dresser L., Matukas L. Common adverse events associated with the use of ribavirin for severe acute respiratory syndrome in Canada. Clin Inf Dis. 2003;37:1139–1142. doi: 10.1086/378304. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Cinatl J., Morgenstern B., Bauer G., Chandra P., Rabenau H., Doerr H.W. Treatment of SARS with human interferons. Lancet. 2003;362:293–294. doi: 10.1016/S0140-6736(03)13973-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Stroher U., DiCaro A., Li Y., Strong J.E., Aoki F., Plummer F., et al. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon-alpha. J Inf Dis. 2004;189:1164–1167. doi: 10.1086/382597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Haines C.J. The effect of Severe Acute Respiratory Syndrome on a hospital obstetrics and gynaecology service. BJOG. 2003;110:643–645. doi: 10.1016/S1470-0328(03)03007-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Woolf S.H., Battista R.N., Angerson G.M., Logan A.G., Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ. 2003;169(3):207–208. [PMC free article] [PubMed] [Google Scholar]

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