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guide clinical management is limited consisting mainly of observational studies and systematic reviews that quickly go out of date.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.