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Obstetrics

Prevention, Evaluation, and Management of Coronavirus (COVID-19) in Pregnancy and Puerperium

The coronavirus disease 2019 (COVID-19) pandemic began in December 2019, and consequent to its many variants, 2 years later, the crisis continues. A droplet-borne virus with mutants displaying characteristics of rapid spread makes it necessary that individuals at risk of poor outcomes need all the affordable protection, education, and management resources. Though it is primarily a pulmonary disease, the extra-pulmonary manifestations and consequences of COVID-19 make it even more challenging to

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Tachycardia, tachypnea, hypoxia (on pulse-oximetry), use of accessory muscles of respiration, and crackles on lung auscultation are the likely findings of the respiratory examination.
  • Chest pain, hemoptysis, and unilateral lower limb swelling could indicate venous thromboembolism.
  • Arrhythmias, hypotension, and peripheral edema could instigate an evaluation for myocardial dysfunction.
  • Patients who are incompletely vaccinated or unvaccinated are at higher risk of progressing to severe COVID-19.
  • Markers on physical examination of an additional risk factor for poor outcomes would include a high body mass index (BMI) (>30 kg/m2), signs of chronic steroid use, and stigmata of liver disease.
  • The gold standard test for evaluating a COVID-19 suspect presently is an RT-PCR of the appropriate respiratory (nasopharyngeal or endotracheal or bronchoalveolar lavage) samples.
  • Blood investigations for the patients include routine blood investigations, including a complete blood count (CBC) with differential, liver, and renal function tests.
  • A lung ultrasound, with the ‘BLUE’ (Bedside Lung Ultrasound in Emergency) protocol, may help further diagnose the cause of respiratory distress in a patient, which may include pulmonary edema (cardiogenic and non-cardiogenic), pulmonary embolism, pneumonia, and even identify pneumothoraces or pneumomediastinum early.
  • From the obstetric point of view, a patient with COVID-19 pneumonia can undergo cardiotocography to assess fetal well-being.
  • A neutrophil-lymphocyte ratio may be of prognostic significance, with high ratios closely related to poor outcomes.
  • Contact history is also extremely important.
Predictive scores for thromboembolism
Predictive scores for thromboembolism are not validated for use in pregnancy.
  • Oxygenation : Though it does not vary significantly in most aspects from non-pregnant individuals, 1 of the basic differences is the threshold for oxygen supplementation, which is at <95% in pregnant individuals.
  • Non-invasive and invasive ventilation initiation is guided further per the patient's respiratory status.
  • Pregnant patients who require hospitalization for COVID-19 are eligible for prophylactic anticoagulation, as are non-pregnant individuals.
  • The choice of anticoagulants in pregnancy is heparins, and between unfractionated heparin and low-molecular-weight heparin (LMWH), the latter is preferred.
Remdesivir
Not specified in source
Adult
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Renal
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Duration
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Unfractionated heparin
Not specified in source
Adult
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Renal
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Duration
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  • Tocilizumab or sarilumab, presently indicated in patients with a rapidly increasing oxygen requirement, cross the placental barrier and may have an immunosuppressive effect on the fetus.
  • Baricitinib and tofacitinib likely cross the placental barrier.
  • Novel oral anticoagulants are presently not recommended for pregnant or lactating mothers due to the lack of safety data and the possibility of transplacental passage, given the smaller molecular size.
  • However, patients who have been on long-term systemic steroids may be unable to mount an adequate immune response once vaccinated.
  • If full proning is not feasible, left lateral decubitus may also be used for pregnant patients.
  • Maternal: Acute respiratory distress syndrome, pulmonary embolism, arrhythmias, placental abruption.
  • Fetal: Preterm birth, stillbirth
  • The risk of anxiety, depression, and several disorders in the anxiety disorders spectrum increases after COVID-19.
  • A routine follow-up with an obstetrician during pregnancy and further monitoring, as per the patient’s presentation, when infected with COVID-19 for both maternal and fetal health is vital to successful outcomes.
  • For a child who tests positive for COVID-19 and remains asymptomatic, a follow-up for at least 2 weeks is recommended, even if discharged.
  • Patients who suffer from severe COVID-19 or ARDS have higher chances of developing post-COVID fibrotic sequelae.
  • review
    Prevention, Evaluation, and Management of Coronavirus (COVID-19) in Pregnancy and Puerperium. StatPearls [Internet] — Mihir R. Gangakhedkar, Alexander Pozun — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov