Dear Editor,
Since December 2019, the outbreak of the novel coronavirus disease 2019 (COVID-19) has rapidly spread from China worldwide until to be declared a pandemic. To date, worldwide, almost 5 million confirmed cases of COVID-19 have been reported.
It is urgent to address the impact of this pandemic on the obstetric and reproductive medicine, seeking for reorganization strategies of daily practice [1,2].
Although professional bodies and experts have provided specific guidance [2], based on current limited evidences, data on obstetric, neonatal and reproductive outcomes are still partial [3]. In many countries after national lockdown, a Phase 2 started relaxing restrictions. To manage this phase, we recommend adopting rigorous preventive measures. Global lockdown has significantly impacted on new births, especially on those obtained with assisted reproductive technology (ART).
Obstetrics patients
-
•
Outpatient management. Avoid unnecessary inpatient monitoring.
-
•
Routine antenatal care should be organized by a triaging procedure. For suspected patients, visits should be deferred; if it cannot be delayed, they should be performed in a dedicated outpatient clinical setting, as for symptomatic or positive patients.
-
•
Telemedicine is encouraged to minimize number of visits.
-
•
Testing for COVID-19 before any obstetric invasive procedure patients is recommended.
-
•
Fetal therapy (for life-saving procedures) should continue to be offered with appropriate consent on risks and benefits.
-
•
For inpatient monitoring, suspected/symptomatic women must be isolated and admitted after a detailed assessment by a multidisciplinary team. Timing and mode of delivery should be patient-tailored based on maternal and fetal status. There is minimal evidence for intrauterine vertical transmission of COVID-19 infection [4].
-
•
Breastfeeding and rooming in may be allowed
Infertility patients
Given that ART babies represent about 0.3 % of the total live birth rate every year and the increasing population decline registered in industrialized countries, a worldwide restart of fertility treatment is necessary. Recently, an international panel of expert identified which patients should be prioritized for fertility care [5]. Advanced age women (i.e. age ≥ 35 years) with low prognosis to ART, tend to lose their fertility potential faster than other infertile women. Other subgroups of women who should be prioritized are those who need urgent fertility preservation, including women affected by systemic autoimmune disorders who presented a restricted timeframe during which fertility preservation is possible. Progressively, once the risk of COVID-19 infection is decreasing, other ART treatment could restart following local regulations. The key principle in ART treatment during Phase II is that COVID-19 symptoms should be excluded before and during ART treatment in patients, staff and anyone attending ART centers.
In conclusion, management of obstetric and infertile women should be carefully performed in countries who are progressively relaxing restrictive measures using strict triaging. Outcome record and data sharing are encouraged to improve our knowledge and address the further phases of COVID-19 pandemic.
Financial support
No financial support was received for this study
Declaration of Competing Interest
The authors report no conflict of interest
References
- 1.Qi H., Chen M., Luo X. Management of a delivery suite during the COVID-19 epidemic [published online ahead of print, 2020 May 20] Eur J Obstet Gynecol Reprod Biol. 2020 doi: 10.1016/j.ejogrb.2020.05.031. S0301-2115(20)30314-30316. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Saccone G., Carbone F.I., Zullo F. The novel coronavirus (2019-nCoV) in pregnancy: what we need to know [published online ahead of print, 2020 Apr 2] Eur J Obstet Gynecol Reprod Biol. 2020 doi: 10.1016/j.ejogrb.2020.04.006. S0301-2115(20)30174-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Martins-Filho P.R., Tanajura D.M., Santos H.P., Jr, Santos V.S. COVID-19 during pregnancy: Potential risk for neurodevelopmental disorders in neonates? [published online ahead of print, 2020 May11] Eur J Obstet Gynecol Reprod Biol. 2020 doi: 10.1016/j.ejogrb.2020.05.015. S0301-2115(20)30264-30265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Carosso A., Cosma S., Serafini P., Benedetto C., Mahmood T. How to reduce the potential risk of vertical transmission of SARS-CoV-2 during vaginal delivery? [published online ahead of print, 2020 May 6] Eur J Obstet Gynecol Reprod Biol. 2020 doi: 10.1016/j.ejogrb.2020.04.065. S0301-2115(20)30251-30257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Alviggi C., Esteves S.C., Orvieto R., Conforti A., La Marca A., Fischer R. COVID-19 and assisted reproductive technology services: repercussions for patients and proposal for individualized clinical management. Reprod Biol Endocrinol. 2020;18(May (1)):45. doi: 10.1186/s12958-020-00605. [DOI] [PMC free article] [PubMed] [Google Scholar]