INTRODUCTION
Coronavirus Disease 19 (COVID-19) is caused by severe acute respiratory
coronavirus-2 (SARS-COV-2), which is a novel strain of coronavirus that
first appeared in December 2019 in Hubei Province,
China.1 Since then, the spread of SARS-COV-2 has
resulted in an unprecedented global pandemic infecting over 4 million
people and killing approximately 300,000 as of May
2020.2 SARS-COV-2 infection causes a spectrum of
clinical manifestations from asymptomatic viral shedding or mild
symptoms resembling those of the common cold to severe influenza-like
illness and viral pneumonia.1 The global mortality
rate reported by the World Health Organisation is approximately 3.4
percent.2
The maternal adaptations to pregnancy can often predispose pregnant
women to a more severe course of respiratory illness.3Certainly, in two previous epidemics over the last 2 decades caused by
similar coronaviruses, MERS and SARS, pregnant women experienced both a
higher morbidity and mortality rate when compared to the non-pregnant
population.4, 5 The UK Obstetric Surveillance System
recently published a national cohort study including 427 women with
COVID-19 infection in pregnancy mostly in the second and third
trimester.6 The commonest symptoms were pyrexia
followed by cough and breathlessness. Approximately 1 in 10 pregnant
women compared to 1 in 100 non-pregnant women required critical care
admission.6 However, there is insufficient evidence at
present to conclude from this data that pregnant women are more
susceptible to COVID-19 or that those with COVID-19 infection are more
prone to developing severe pneumonia.
The unique requirements of pregnancy with the potential for perinatal
and maternal morbidity present a significant challenge to our maternity
services. This demands a unified response from national and
international organisations to ensure an evidence-based and coherent
approach in the management of pregnant women with COVID-19. Thus,
guidelines are rapidly being developed in the UK by the Royal College of
Obstetricians and Gynaecologists (RCOG)7 and,
internationally, by the International Federation of Obstetrics &
Gynaecology (FIGO)8 and the International Society of
Ultrasound in Obstetrics & Gynaecology (ISUOG).9However, due to the novelty of the infection, the evidence currently
available to guide clinical management is limited consisting mainly of
observational studies and systematic reviews that quickly go out of
date.
Our objectives are, first, to compare the recommendations set out in the
most recent version of the RCOG guidelines on the management of COVID-19
infection in pregnancy with those in the international guidelines
published by ISUOG and FIGO and, second, to review the supporting
evidence for these recommendations.