Management strategy of pregnant women during COVID-19 pandemic.

Due to the spread of pneumonia caused by a new coronavirus COVID‐19 from Wuhan City, China, COVID‐19 infection has been developing into a pandemic, and the situation has become more serious as the number of infected people and deaths increase all over the world, including Japan. COVID‐19 may rapidly cause severe pneumonia and we should anticipate a shortage of ventilators and the need for choice of which patients should use them. Although there have been no apparent reports of exacerbation of the disease or fetal disorders in pregnant women, pneumonia in pregnant women can generally be severe because the diaphragm is lifted and it is easily compressible.

Pregnant women sometimes test positive even though they are asymptomatic as outpatients, so it is necessary to screen all pregnant women universally by polymerase chain reaction for SARS‐CoV‐2, the virus that causes COVID‐19. , , We now, as a challenge, intend to conduct a screening test for every pregnant woman on admission to distinguish between positives and negatives and examine what management policy is preferable (Fig. 1). Even if the result is negative, it may be desirable to discontinue the pregnant woman's and family’s health check‐up and perform online medical treatment by telephone, including cases who have a history of overseas travel or if a pregnant woman is associated with close contacts with infectious patients, or asymptomatic COVID‐19 positive pregnant women. In addition, in the female positive cases, the necessity of hospital management is classified according to the presence or absence of respiratory disorders (Fig. 1). When perinatal care is required, management in a negative pressure room will be adopted if possible, and the delivery management policy will be adopted at the optimal time. The delivery mode will be caesarean section, unless labour progresses rapidly. This is to prioritise maternal and child care, and the health care of our medical workers.

Figure 1

Flowchart of pregnant women management during COVID‐19 prevalence.

We believe that if such a maternal medical system, hopefully accompanied with highly sensitive anti‐SARS‐CoV‐2 antibody and virus antigen tests, can be constructed, it will be very useful for the safe management of medical facilities and workers. Postpartum, rapid mother‐child separation of COVID‐19 positive women is needed as soon as possible and synthetic milk is better for the infant in order to prevent neonatal infection of COVID‐19. To prevent the collapse of the medical care system, comprehensive management of medical facilities and workers is now urgently required around the world.