Wearing of a mask in our office is OPTIONAL.  If you or anyone accompanying you is SICK with respiratory or gastrointestinal symptoms, please reschedule.

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COVID-19

COVID-19 and Pregnancy  – (update 05/22/2022)

Pregnant women do not appear to be at higher likelihood to acquire the coronavirus than non-pregnant women, but the disease course of COVID-19 may be more severe. For this reason, take extra care in preventing virus exposure.  More than 50% of women who get ill from the coronavirus got it from someone who did not have symptoms at the time.  You have to do more than just “avoid sick people”!  Understandably, the 2022 omicron variants are extremely contagious, and despite your best efforts infections are bound to happen to vaccinated and unvaccinated women. Still, vaccination is your best defense against severe disease, hospitalization, prenatal complications, and death.

If you have COVID-19 symptoms or you are concerned that you may have been exposed to COVID-19, please get tested. We cannot see patients with symptoms of Covid, or test patients for Covid, due to our OSHA compliance categorization. Your primary care provider may do testing in their office. Also, the North Carolina COVID-19 information hotline is 866-462-3821, and is for questions about the virus and for testing locations. In general, if you are experiencing fever, cough or shortness of breath, we request you call the office to postpone your appointment.  See our main Covid Updates page for re-scheduling guidance.

Covid Antigen at-home tests are again readily available for purchase at local retailers.  Or, visit the NC DHHS website for testing locations,  Due to the unique presentation of omicron variant, consider swabbing your throat in addition to nasal passage.

If you do acquire COVID-19, it is likely due to the omicron variant (including BA.2) and >90% will only have mild disease (no shortness of breath) and can remain at home. Notify our office if you have COVID-19. We will have regular telephone contact with you, assessing for worsening of your illness and the need for hospital care. We will also reschedule your prenatal appointments to accommodate your isolation.

IF YOU GET COVID DISEASE WHILE PREGNANT…

Notify

Please notify our office if you get Covid; this can wait until regular business hours, or just send a message in the Patient Portal.  We like to keep track of your progressing course, give you practical health advice, and assist in rescheduling appointments.

Isolate

You should isolate yourself from others, to reduce the risk of infection (although, most already transmit the virus several days before a positive test).

Home Care

The omicron variants domintate our community at this time.  Fortunately, instead of pneumonia, omicron symptoms are mainly sore throat and nasal congestion. Fatigue, headache, diarrhea, and a brief fever are common too. Make sure that you are really good about hydration.  You may take any of the cold preparations on our safe-medications list. Call the office or seek emergency room care if you experience worsening breathing ability, unremitting fever >102°F despite appropriate use of acetaminophen, inability to tolerate oral hydration and medications, persistant chest pain with deep breaths, confusion, or obstetric complications (e.g., preterm contractions, vaginal bleeding, rupture of membranes, decreased fetal activity).  Presistant respiratory rate ≥20 to 24 breaths/minute and/or heart rate >100 beats per minute are also signs of worsening disease. Those in the third trimester should perform fetal kick counts and report decreased fetal movement.

Therapy

Pregnancy itself increases your risk for severe disease, hospitalization, and death.  There is some limited evidence that it may also increase the likelihood of preterm birth and stillbirth in unvaccinated women. Therapeutics only modestly improve symptoms, but they do shorten the course of your illness and reduce hospitalization and death by 89 percent!   Therapeutics include oral anti-viral pills and monoclonal antibody intravenous infusions. These therapuetics are appropriate for all pregnant women, and can be especially important for women who have other risk factors (hypertension, kidney disease, asthma, diabetes, obesity, weak immune system, and others).  Monoclonal antibody IV infusions are not currenlty used for most omicron infections.
  • Paxlovid (nirmatrelvir/ritonavir) is an oral antiviral pill combination.  The medication has received an Emergency Use Athorization in the United States, including for pregnant patients. In a trial in adult outpatients with at least one risk factor for severe disease, nirmatrelvir-ritonavir, administered within three days of symptom onset, reduced the risk of hospitalization or death. The Society for Maternal Fetal Medicine issued a statement supporting the use of Paxlovid in pregnancy. Although only minimal reproductive safety data from animal studies are available for nimatrelvir (eg, reduced fetal body weights in rabbits when exposed to doses 10-fold higher than authorized human maternal doses), extensive data are available for ritonavir in patients with HIV and no increased risk of overall teratogenic effects has been observed following first-trimester exposure. There are no data on the presence of nirmatrelvir in breast milk, the effects on the breastfed infant, or the effects on milk production. Limited data suggest that ritonavir is present in breast milk, but no information is available on the effects on the breastfed infant or the effects on milk production. Lactation is not a contraindication to use, but interruption of breast feeding during maternal treatment may be prudent.
    • Paxlovid is now our preferred therapeutic for pregnant women.  It has the equivalent effect as monoclonal antibody treatment, but is more available and requires fewer resources. Side-effects are very rare (<1%) and include diarrhea, altered taste, hypertension, and muscle aches.
      > The typical dose is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) — with all three tablets taken together, twice daily for 5 days (30 pills in total).
    • Paxlovid is now available at most major community pharmacies.
    • If you would like Arbor ObGyn to prescribe the antiviral pill treatment, we ask you to locate a nearby pharmacy with Paxlovid in-stock.  Contact the pharmacy directly to confirm Paxlovid availability. Call us or send a portal message indicating your desire to take Paxlovid, AND you pharmacy location.
    • Please review the UNC Health Paxlovid Infosheet, and emergency use Patient Fact Sheet. Also, view a useful video from UNC Health on Paxlovid therapuetic pills.

Prenatal Care

In general, your care after recovering from COVID-19 will not differ from your original prental care plan, except for the addition of an ultrasound in the third trimester.  Some clinical experts think that Covid infection can be associated with low amniotic fluid levels and/or limits on the baby’s growth.  Therefore, we will check a growth/fluid ultrasound for your baby around 32-36 weeks (or at least 14 days from symptom resolution).  Additional fetal testing such as non-stress tests or biophysical profiles are not recommended.

Delivery

Ideally, birth will occur sometime after recovery. Induction of labor and cesarean birth are not recommended as a treatment plan for a history of asymptomatic or nonsevere prental Covid infection.

 

ABOUT THE COVID-19 VACCINE

Should pregnant women get the Covid-19 Vaccine?

Yes. Pregnant women who are eligible recipients should get the vaccine (updated guidance 01/26/22).
American College of Ob & Gyn (ACOG) statement

Can I breastfeed after the Covid-19 Vaccine?

Yes. The Academy of Breastfeeding Medicine (ABM) states that the vaccine is safe for lactating women.
Academy of Breastfeeding Medicine statement

Will the Covid-19 Vaccine cause infertility?

No. The American Society for Reproductive Medicine (ASRM) states that women planning for pregnancy should not avoid the vaccine if they are eligible recipients.
American Society for Reproductive Medicine (ASRM) FAQs

If I choose not to get the vaccine, will Arbor provide me with a written waiver/exception?

No.  It is recommended for pregnant women to receive the vaccine, and there is no medical reason to avoid it.  We are glad to provide a statement that confirms you are pregnant and indicate your due date.  However, decisions about employability based on vaccination status are between you and your employer.

REX HOSPITAL BIRTH CENTER

The Women’s Center is open and fully staffed for deliveries and postpartum care, and has coronavirus mitigation measures in place.

  • As of 03/23/2022, Rex no longer does asymptomatic Covid testing for pre-surgery, pre-labor, or labor pateints. 
  • All patients and support persons will be issued a mask and are required to wear a mask over mouth and nose when outside of their room or, when anyone else enters their room.  Your obstetricians understand that wearing a mask while laboring is a challenge.  Speak with us during labor to see what accommodations can be made.
  • Keep in mind that guest restrictions are evolving. You can view UNC Rex’s up-to-date full visitor policy on their website.

PREGNANCY AND THE WORKPLACE

Pregnant women may continue to go to work. The same commonsense community prevention techniques should be use at work as well. We will not recommend disability due to the pregnancy. Vaccination is your best defense against severe disease, hospitalization, and death.  If you request a letter from us, below is the template that you can expect us to provide to your employer.

___________ is an existing patient of Arbor Obstetrics & Gynecology, and currently pregnant. The CDC defines pregnancy as an underlying health condition that might put her at increased risk for severe illness if she gets a COVID-19 infection. The CDC states that individuals who are at higher risk for severe illness need to take extra precautions during the COVID-19 pandemic. Considering this employee’s underlying health condition (pregnancy), it would be preferable to make accommodations to place this employee in an area that minimizes exposure to COVID-19, or if not feasible, allow them to work from home. Reasonable accommodations include: limiting prolonged close contact with others, working in an environment where she/others wear a mask, and access to best sanitation practices. If that is not feasible, then this employee may need to be placed on medical leave during the COVID-19 pandemic.

FOR PREGNANT HEALTHCARE WORKERS

Our current guidance for pregnant women who are also healthcare workers does not mandate removal from the workplace. Vaccination is your best defense against severe disease, hospitalization, and death. Please let us know If you would like us to formalize a letter to your employer with following guidelines:

Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Be sure your employer knows you are pregnant before you provide any direct patient care to a person with confirmed or suspected COVID-19. When possible, and depending on staffing, management should consider limiting your exposure to these patients. This is especially true if you perform procedures with a higher chance of coming into contact with a patient’s respiratory droplets (such as intubation).

If you do provide care to a patient with confirmed or suspected COVID-19, be sure to follow the Standard, Contact, and Airborne Precautions for all healthcare workers, as outlined by CDC. If you are pregnant and you cared for a patient with COVID-19 without all the recommended precautions in place (for example, no PPE), contact your employer immediately to let them know. Depending on the type of care you are involved in and current staffing needs, your employer may ask you to test for COVID, self-quarantine (stay at home) for a period of time, or to monitor yourself for symptoms (such as fever) while continuing to report to work.

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