Table 2.

Consensus on Recommendations Classified by Phase of Care of Pregnancy

Antepartum care
Title	Prenatal infection screening	Prenatal appointment	US frequency	US equipment/patient rooms	Antenatal surveillance	Antenatal corticosteroids	GBS screening
Consensus on recommendations	Triage symptomatic patients via telehealth Test anyone with new flulike symptoms Prioritize high-risk patients: older, immunocompromised, advanced HIV, homeless, hemodialysis Use drive-through or standalone testing area All suspected cases should be screened using qRT-PCR Symptomatic patients should be treated as positive until results are back Repeat testing in 24 h if negative but still high suspicion	Elective and nonurgent appointments should be postponed or completed by telehealth Encourage use of telehealth for all visits HCW meetings should be conducted via virtual/audio platform, if feasible Reserve F2F visits for 11-13, 20, 28, 36 wk and weekly after 37 wk Complete laboratory tests and US on same visit day Limit support person at outpatient F2F visits	Consensus: Continue US as medically indicated when possible SMFM suggestions: Combine dating and nuchal translucency US in first trimester Anatomy scan at 20-22 wk Consider stopping serial CL after anatomy US if transvaginal US CL ≥35 mm, previous preterm birth at >34 wk Body mass index >40: schedule at 22 wk to reduce risk of suboptimal views/need for follow-up Single growth F/U at 32 wk Low-lying placenta F/U 34-36 wk	Must be cleaned with disinfectant per manufacturer guidelines after EVERY use Deep clean all instruments and room in the case of a positive patient	Reserve for medically indicated screening Limit NST <32 wk Twice weekly NST only for fetal growth restriction with abnormal umbilical arterial Doppler studies, complicated monochorionic twins, or Kell-sensitized patients with significant titers If patient needs US, perform biophysical profile instead of NST Kick counts instead of NST for low-risk patients Daily NST if patient hospitalized	Should continue if <34 wk, even if tested positive for COVID-19 Balance risks and benefits for 34 0/7 to 36 6/7 wk Other modifications should be individualized	As indicated between 36 0/7 and 37 6/7 wk gestation Consider grouping with other visits in the same time frame Patients can self-collect with proper instructions if the resources and infrastructure allow

Intrapartum care
Title	Predelivery preparation/screening	Delivery location	Delivery time	Mode of delivery	Support person	Obstetric analgesia and anesthesia	Oxygen use	Second stage of labor	Third stage of labor	Umbilical cord clamping	PPE
Consensus on recommendations	Social distancing and off work for 2 wk before anticipated delivery (start at ∼37 wk) Screen patient and partner on phone day before admission Limit HCW staffing to only essential staff	Designated isolation room, for suspected or confirmed cases of COVID-19	Based on routine obstetric indications Early delivery should be considered for critically ill patients No contraindications to IOL unless there are limited beds	Based on routine obstetric indications COVID-19 infection is not an indication for CD Expedite delivery by CD in the setting of fetal distress or maternal deterioration Water births should be avoided	Allowed 1 consistent asymptomatic support person	No evidence against regional or general anesthesia Epidural analgesia is recommended to women with suspected or confirmed COVID-19 to minimize the need for GA if urgent delivery is needed Avoid use of nitrous oxide	Do not use oxygen for intrauterine resuscitation Consider aerosolizing HCWs must wear appropriate PPE (N95)	Do not delay pushing Consider shortening with operative delivery to minimize aerosolization and maternal respiratory effort	Consider active management to reduce blood loss (national blood shortage)	Delayed cord clamping is still recommended in the absence of contraindications Avoid delayed cord clamping in confirmed and suspected cases	-Asymptomatic or negative patients: Patient and provider wear surgical mask Aerosolizing procedures: N95 for patient and N95, gown, gloves, face shield for provider

Postpartum care
Title	Placental and fetal tissue	Length of stay	Breastfeeding	Skin to skin	Postpartum pain control	Postpartum visit
Consensus on recommendations	ISUOG recommendations: Should be handled as infectious tissue in positive patients Consider qRT-PCR on placenta	Expedited discharge should be considered if stable. VD → 1 d CD → 2 d	Limited evidence to advise against breastfeeding Advise patients to (1) practice respiratory hygiene during feeding, (2) wear a mask, (3) wash hands before and after touching the baby, (4) routinely clean and disinfect surfaces they have touched During separation, encourage dedicated breast pumping	Routine precautionary separation of a healthy baby and mother is not advised Encourage good hygiene and appropriate PPE for COVID-19–positive patients	No contraindication to NSAID use	Encourage telehealth for postpartum visit Limit F2F visits only for medically necessary concerns

CD = cesarean delivery; CL = cervical length; COVID-19 = coronavirus disease 2019; F2F = face to face; F/U = follow-up; GA = general anesthesia; GBS = group B streptococcus; HCW = health care worker; HIV = human immunodeficiency virus; IOL = induction of labor; ISUOG = International Society of Ultrasound in Obstetrics and Gynecology; NSAID = nonsteroidal anti-inflammatory drug; NST = nonstress test; PPE = personal protective equipment; qRT-PCR = quantitative reverse transcriptase polymerase chain reaction; SMFM = Society for Maternal-Fetal Medicine; US = ultrasonography; VD = vaginal delivery.