Table 3.
Main differences among the 11 guidelines.
| Topics | RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO |
| ANTENATAL CARE | ||||||||
| Mask Wearing | Pregnant women screened positive for SARS-CoV-2 infection | Apply local guidance | Apply local guidance | Women with acute respiratory symptoms | Pregnant women screened positive for SARS-CoV-2 infection | Women who test positive/PUI women at all times as clinically able * | People visiting a hospital or other high-risk area | NR |
| Personal/social Hygiene | Especially >28 weeks of gestation, distance of at least two meters between individuals |
Distance of at least one meter between individuals | Reduce social interactions | Reduce social interactions | Distance of at least one meter between individuals | Reduce social interactions | Distance of at least two meters or six feet between individuals | Reduce social interactions |
| Antenatal visits | Delay visits until the end of self-confinement period | Postpone routine follow-up appointments by 14 days or until positive/two consecutive negative test results | NR | NR | When possible postpone visits, by taking note into the clinical file. | NR | Offer all visits for obstetric emergencies **/postpone routine follow-up appointments by 14 days or until positive/two consecutive negative test results |
Guarantee to all pregnant women, including those with confirmed/suspected COVID-19, high quality of care before, during, and after childbirth (including mental health care) |
| Partner/companion | Come alone to the visits or with one person maximum | Consider reducing the number of visitors to the department |
Consider reducing the number of visitors to the department. |
Come alone to the visits or with one person maximum | Positive partner: notify your obstetric team: access forbidden | Consider reducing the number of visitors to the department *** | Come alone to the visits | NR |
| RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO | |
| INTRAPARTUM CARE | ||||||||
| Antenatal Corticosteroids | - Steroids for standard care - Do not delay urgent intervention to allow steroid administration |
- Avoid steroids in critical patients - Discuss steroids administration with MDC - Avoid tocolysis |
Steroids to all viable premature fetuses | - Steroids administration on individual basis - Discuss steroids administration with MTD |
NR | - Steroids administration on individual basis - Particular caution for critically ill women in ICU setting |
- Avoid steroids in critical patients - Discuss steroids administration with MDC - Avoid tocolysis |
NR |
| Respiratory Analgesia | Entonox allowed (with disposable filter) |
NR | NR | Respiratory analgesia is not recommended | NR | Consider suspending use of nitrous oxide | NR | NR |
| Cord Clamping | Delayed cord clamping recommended | Prompt cord clamping | Delayed cord-clamping not recommended for women infected with COVID-19 |
Delayed clamping allowed if maternal and newborn isolation can be done properly | Prompt cord clamping | NR | Prompt cord clamping | NR |
| Skin to skin practice | NR | NR | NR | Skin to skin is allowed if maternal and newborn isolation can be done properly | Avoid skin to skin | NR | NR | Skin to skin is allowed |
| RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO | |
| POSTPARTUM CARE | ||||||||
| Mother/child separation | Healthy babies stay with their mothers | Separation for severely/critically ill mothers | Infants isolated and monitored for 14 days | Separation based on maternal test and symptoms | Separation based on maternal test and symptoms | Separation based on maternal test, symptoms, and willingness. | Separation for severely/critically ill mothers | Women should be supported to share a room with their baby |
| Breastfeeding | The benefits outweigh any potential risks of transmission of the virus | Can be considered for asymptomatic/mildly affected patients **** | Avoid direct breastfeeding | Allowed depending on maternal clinical state symptoms | Allowed **** /*** |
Pumping recommended for SARS-CoV-2 positive/PUI women **** | Can be considered for asymptomatic/mildly affected patients **** | Women can breastfeed safely **/**** |
| RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO | |
| ANTENATAL CARE | ||||||||
| Mask Wearing | Pregnant women screened positive for SARS-CoV-2 infection | Apply local guidance | Apply local guidance | Women with acute respiratory symptoms | Pregnant women screened positive for SARS-CoV-2 infection | Women who test positive/PUI women at all times as clinically able * | People visiting a hospital or other high-risk area | NR |
| Personal/social Hygiene | Especially > 28 weeks of gestation, distance of at least two meters between individuals |
Distance of at least one meter between individuals | Reduce social interactions | Reduce social interactions | Distance of at least one meter between individuals | Reduce social interactions | Distance of at least two meters or six feet between individuals | Reduce social interactions |
| Antenatal visits | Delay visits until the end of self-confinement period | Postpone routine follow-up appointments by 14 days or until positive/two consecutive negative test results | NR | NR | When possible postpone visits by taking note into the clinical file. | NR | Offer all visits for obstetric emergencies **/postpone routine follow-up appointments by 14 days or until positive/two consecutive negative test results |
Guarantee to all pregnant women, including those with confirmed/suspected COVID-19, high quality of care before, during and after childbirth |
| Partner/companion | Come alone to the visits or with one person maximum | Consider reducing the number of visitors to the department |
Consider reducing the number of visitors to the department. |
Come alone to the visits or with one person maximum | Positive partner: notify your obstetric team: access forbidden | Consider reducing the number of visitors to the department *** | Come alone to the visits | NR |
| RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO | |
| INTRAPARTUM CARE | ||||||||
| Antenatal Corticosteroids | - Steroids for standard care - Do not delay urgent intervention to allow steroid administration |
- Avoid steroids in critical patients - Discuss steroids administration with MDC - Avoid tocolysis |
Steroids to all viable premature fetuses | - Steroids administration on individual basis - Discuss steroids administration with MTD |
NR | - Steroids administration on individual basis - Particular caution for critically ill women in ICU setting |
- Avoid steroids in critical patients - Discuss steroids administration with MDC - Avoid tocolysis |
NR |
| Respiratory Analgesia | Entonox allowed (with disposable filter) |
NR | NR | Respiratory analgesia is not recommended | NR | Consider suspending use of nitrous oxide | NR | NR |
| Cord Clamping | Delayed cord clamping recommended | Prompt cord clamping | Delayed cord clamping not recommended for women infected with COVID-19 |
Delayed clamping allowed if maternal and newborn isolation can be done properly | Prompt cord clamping | NR | Prompt cord clamping | NR |
| Skin to skin practice | NR | NR | NR | Skin to skin is allowed if maternal and newborn isolation can be done properly | Avoid skin to skin | NR | NR | Skin to skin is allowed |
| RCOG | ISUOG | CHINA | SPAIN MOH | AOGOI/SIGO/Italian MOH | ACOG/CDC/SMFM | FIGO | WHO | |
| POSTPARTUM CARE | ||||||||
| Mother/child separation | Healthy babies stay with their mothers | Separation for severely/critically ill mothers | Infants isolated and monitored for 14 days | Separation based on maternal test and symptoms | Separation based on maternal test and symptoms | Separation based on maternal test, symptoms, and willingness | Separation for severely/critically ill mothers | Women should be supported to share a room with their baby |
| Breastfeeding | The benefits outweigh any potential risks of transmission of the virus | Can be considered for asymptomatic/mildly affected patients **** | Avoid direct breastfeeding | Allowed depending on maternal clinical state symptoms | Allowed ****/***** | Pumping recommended for SARS-CoV-2 positive/PUI women **** | Can be considered for asymptomatic/mildly affected patients **** | Women can breastfeed safely ****/****** |
NR = No Recommendation provided; *: All visitors, if available, in areas of high community prevalence; **: in agreement with current local guidelines; ***: Exceptions could be made for settings of bereavement/If visitors are permitted, they should be screened for symptoms of respiratory illness Before entering a healthcare facility); ****: Mothers should ensure to wash their hands and to wear a three-ply surgical mask before touching the baby; *****: Use donated human milk when possible, especially if mother and newborn are separated; ******: keep all surfaces clean.