The coronavirus disease 2019 (COVID-19) pandemic has represented a major impact to health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. The mother and fetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-fetal medicine practice have suffered profound changes to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists in order to correctly diagnose the disease, classify the severity, distinguish specific signs of COVID-19 from those of obstetric complications, and take the most appropriate management decisions. In this review we present in a highly concise manner an evidence-based protocol for the management of COVID-19 in pregnancy. We briefly contemplate all relevant aspects that we believe a specialist in obstetrics and maternal medicine should know, ranging from basic concepts about the disease and protection measures in the obstetric setting to more specific aspects related to maternal-fetal management and childbirth.

1.
World Health Organization (WHO)
. “
Coronavirus disease 2019 (COVID-19) Situation Report – 97.
” [Online]. Available: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200426-sitrep-97-covid-19.pdf?sfvrsn=d1c3e800_6. [Accessed: 27-Apr-2020].
2.
Andersen
KG
,
Rambaut
A
,
Lipkin
WI
,
Holmes
EC
,
Garry
RF
.
The proximal origin of SARS-CoV-2
.
Nat Med
.
2020
Apr
;
26
(
4
):
450
2
.
[PubMed]
1078-8956
3.
Li
Q
,
Guan
X
,
Wu
P
,
Wang
X
,
Zhou
L
,
Tong
Y
, et al.
Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia
.
N Engl J Med
.
2020
Mar
;
382
(
13
):
1199
207
.
[PubMed]
0028-4793
4.
Wu
J
, et al.
“Detection and analysis of nucleic acid in various biological samples of COVID-19 patients.,” Travel Med. Infect
.
DISP
.
2020
Apr
;
•••
:
101673
.0251-3625
5.
Yan
J
,
Guo
J
,
Fan
C
,
Juan
J
,
Yu
X
,
Li
J
, et al.
Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases
.
Am J Obstet Gynecol
.
2020
Apr
;
S0002-9378(20)30462-2
.
[PubMed]
0002-9378
6.
Di Mascio
D
,
Khalil
A
,
Saccone
G
,
Rizzo
G
,
Buca
D
,
Liberati
M
, et al.
Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis
.
Am J Obstet Gynecol MFM
.
2020
Mar
;(
Mar
):
100107
.
[PubMed]
2589-9333
7.
A.
Amouroux
,
T.
Attie-Bitach
,
J.
Martinovic
,
M.
Leruez-Ville
, and
Y.
Villes
, “
Evidence for and against vertical transmission for SARS-CoV-2 (COVID-19)
,” Am J Obs. Gynecol, vol. Accepted,
2020
.
8.
Chen
H
,
Guo
J
,
Wang
C
,
Luo
F
,
Yu
X
,
Zhang
W
, et al.
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records
.
Lancet
.
2020
Mar
;
395
(
10226
):
809
15
.
[PubMed]
0140-6736
9.
Wang
W
, et al.
Detection of SARS-CoV-2 in Different Types of Clinical Specimens
,” JAMA - Journal of the American Medical Association. American Medical Association,
2020
.
10.
Lauer
SA
,
Grantz
KH
,
Bi
Q
,
Jones
FK
,
Zheng
Q
,
Meredith
HR
, et al.
The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: estimation and Application
.
Ann Intern Med
.
2020
Mar
;
172
(
9
):
577
.
[PubMed]
0003-4819
11.
Zhou
F
,
Yu
T
,
Du
R
,
Fan
G
,
Liu
Y
,
Liu
Z
, et al.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
.
Lancet
.
2020
Mar
;
395
(
10229
):
1054
62
.
[PubMed]
0140-6736
12.
Lai
CC
, et al.
“Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths,” Journal of Microbiology, Immunology and Infection
.
Elsevier Ltd
;
2020
.
13.
Guan
WJ
,
Ni
ZY
,
Hu
Y
,
Liang
WH
,
Ou
CQ
,
He
JX
, et al.;
China Medical Treatment Expert Group for Covid-19
.
Clinical Characteristics of Coronavirus Disease 2019 in China
.
N Engl J Med
.
2020
Apr
;
382
(
18
):
1708
20
.
[PubMed]
0028-4793
14.
Wong
HY
,
Lam
HY
,
Fong
AH
,
Leung
ST
,
Chin
TW
,
Lo
CS
, et al.
Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients
.
Radiology
.
2019
Mar
;(
Mar
):
201160
.
[PubMed]
0033-8419
15.
ISCIII
. “
Informe no 22. Situación de COVID-19 en España a 13 de abril de 2020.
” [Online]. Available: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/INFORMES/InformesCOVID-19/Informe no 22. Situación de COVID-19 en España a 13 de abril de
2020
.pdf. [Accessed: 13-Apr-2020].
16.
Ferrazzi
EM
,
Frigerio
L
,
Cetin
I
,
Vergani
P
,
Spinillo
A
,
Prefumo
F
, et al.
COVID-19 Obstetrics Task Force, Lombardy, Italy: executive management summary and short report of outcome
.
Int J Gynaecol Obstet
.
2020
Apr
.
[PubMed]
0020-7292
17.
Breslin
N
,
Baptiste
C
,
Gyamfi-Bannerman
C
,
Miller
R
,
Martinez
R
,
Bernstein
K
, et al.
COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals
.
Am J Obstet Gynecol MFM
.
2020
Apr
;(
Apr
):
100118
.
[PubMed]
2589-9333
18.
L.
Zeng
, et al.
, “
Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China
,” JAMA Pediatr., Mar.
2020
.
19.
CDC
. “
People Who Are at Higher Risk for Severe Illness | CDC.
” [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html. [Accessed: 27-Apr-2020].
20.
Kerr
SM
,
Parker
SE
,
Mitchell
AA
,
Tinker
SC
,
Werler
MM
.
Periconceptional maternal fever, folic acid intake, and the risk for neural tube defects
.
Ann Epidemiol
.
2017
Dec
;
27
(
12
):
777
782.e1
.
[PubMed]
1047-2797
21.
Rasmussen
SA
,
Smulian
JC
,
Lednicky
JA
,
Wen
TS
,
Jamieson
DJ
.
Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know
.
Am J Obstet Gynecol
.
2020
May
;
222
(
5
):
415
26
.
[PubMed]
0002-9378
22.
Tang
P
,
Wang
J
,
Song
Y
.
Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review
.
BMC Pregnancy Childbirth
.
2018
Nov
;
18
(
1
):
434
.
[PubMed]
1471-2393
23.
S.
Tomlinson
,
S.
Behrmann
,
J.
Cranford
,
M.
Louie
, and
A.
Hashikawa
, “
Accuracy of Smartphone-Based Pulse Oximetry Compared with Hospital-Grade Pulse Oximetry in Healthy Children
,” Telemed. e-Health, vol. 24, no. 7, pp. 527–535, Jul.
2018
.
24.
Sanders
JM
,
Monogue
ML
,
Jodlowski
TZ
,
Cutrell
JB
.
Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review
.
JAMA
.
2020
Apr
.
[PubMed]
0098-7484
25.
F.
Figueras
,
E.
Llurba
,
R. J.
Martinez‐Portilla
,
J.
Mora
,
F.
Crispi
, and
E.
Gratacos
, “
SARS-CoV-2 causing HELLP-like syndrome in pregnancy and the role of angiogenic factors for differential diagnosis: experience from the first 27 infected pregnant women in Spain
,” Lancet. Infect. Dis.
26.
Zeisler
H
,
Llurba
E
,
Chantraine
F
,
Vatish
M
,
Staff
AC
,
Sennström
M
, et al.
Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia
.
N Engl J Med
.
2016
Jan
;
374
(
1
):
13
22
.
[PubMed]
0028-4793
27.
Schwartz
DA
.
An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes
.
Arch Pathol Lab Med
.
2020
Mar
;
arpa.2020-0901-SA
.
[PubMed]
0003-9985
28.
“Interim Considerations for Obstetric Anesthesia Care Related to COVID19 - SOAP.” [Online]. Available: https://soap.org/education/provider-education/expert-summaries/interim-considerations-for-obstetric-anesthesia-care-related-to-covid19/. [Accessed: 15-Apr-2020].
29.
L. C.
Poon
, et al.
, “
ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals
,” Ultrasound Obstet. Gynecol., p. uog.22013, Mar.
2020
.
30.
“Clinical management of severe acute respiratory infection when COVID-19 is suspected.” [Online]. Available: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. [Accessed: 15-Apr-2020].
31.
E. L.
Scholten
,
J. R.
Beitler
,
G. K.
Prisk
, and
A.
Malhotra
, “
Treatment of ARDS With Prone Positioning
,” Chest, vol. 151, no. 1. Elsevier Inc, pp. 215–224, 01-Jan-2017.
32.
“Considerations for Inpatient Obstetric Healthcare Settings | CDC.” [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html. [Accessed: 15-Apr-2020].
33.
Day
M
.
Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
.
BMJ
.
2020
Mar
;
368
:
m1086
.
[PubMed]
0959-8138
34.
Tang
N
,
Bai
H
,
Chen
X
,
Gong
J
,
Li
D
,
Sun
Z
.
Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy
.
J Thromb Haemost
.
2020
Mar
;
18
(
5
):
1094
9
. 1538-7933
35.
“Coronavirus Disease (COVID-19) and Breastfeeding | Breastfeeding | CDC.” [Online]. Available: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html. [Accessed: 15-Apr-2020].
36.
“Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages.” [Online]. Available: https://www.who.int/publications-detail/rational-use-of-personal-protective-equipment-for-coronavirus-disease-(covid-19)-and-considerations-during-severe-shortages. [Accessed: 15-Apr-2020].
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