key: cord-299159-cxktdaws
authors: Boelig, Rupsa C.; Saccone, Gabriele; Bellussi, Federica; Berghella, Vincenzo
title: MFM Guidance for COVID-19
date: 2020-03-19
journal: Am J Obstet Gynecol MFM
DOI: 10.1016/j.ajogmf.2020.100106
sha: 
doc_id: 299159
cord_uid: cxktdaws

The World Health Organization (WHO) has declared COVID-19 a global pandemic. Healthcare providers should prepare internal guidelines covering all aspect of the organization in order to have their unit ready as soon as possible. This document addresses the current COVID-19 pandemic for maternal-fetal medicine (MFM) practitioners. The goals the guidelines put forth here are two fold- first to reduce patient risk through healthcare exposure, understanding that asymptomatic health systems/healthcare providers may become the most common vector for transmission, and second to reduce the public health burden of COVID-19 transmission throughout the general population. Box 1 outlines general guidance to prevent spread of COVID-19 and protect our obstetric patients. Section 1 outlines suggested modifications of outpatient obstetrical (prenatal) visits. Section 2 details suggested scheduling of obstetrical ultrasound. Section 3 reviews suggested modification of nonstress tests (NST) and biophysical profiles (BPP). Section 4 reviews suggested visitor policy for obstetric outpatient office. Section 5 discusses the role of trainees and medical education in the setting of a pandemic. These are suggestions, which can be adapted to local needs and capabilities. Guidance is changing rapidly, so please continue to watch for updates.

The World Health Organization (WHO) has declared COVID-19 a global pandemic. Healthcare 19 providers should prepare internal guidelines covering all aspect of the organization in order to have 20 their unit ready as soon as possible. This document addresses the current COVID-19 pandemic for 21 maternal-fetal medicine (MFM) practitioners. The goals the guidelines put forth here are two fold-22 first to reduce patient risk through healthcare exposure, understanding that asymptomatic health 23 systems/healthcare providers may become the most common vector for transmission, and second to 24 reduce the public health burden of COVID-19 transmission throughout the general population. Box 25 1 outlines general guidance to prevent spread of COVID-19 and protect our obstetric patients. 26 Section 1 outlines suggested modifications of outpatient obstetrical (prenatal) visits. Section 2 27 details suggested scheduling of obstetrical ultrasound. Section 3 reviews suggested modification of 28 nonstress tests (NST) and biophysical profiles (BPP). Section 4 reviews suggested visitor policy for 29 obstetric outpatient office. Section 5 discusses the role of trainees and medical education in the 30 setting of a pandemic. These are suggestions, which can be adapted to local needs and capabilities.

Guidance is changing rapidly, so please continue to watch for updates. All new obstetrical intakes should be completed by telehealth / remotely unless the patient describes 40 an urgent problem in which case she will be appointed as an urgent in-person visit. The standard 41 timing for IN PERSON encounters in routine, uncomplicated pregnancies are described in Table 1 .

The hope is that necessary laboratory work and/or ultrasounds can be done at the same visit.

Consideration may also be given to having laboratory work performed at lower volume satellite 44 office sites where ability to accomplish social distancing is more easily attained, as feasible. Table 3 illustrates how antenatal surveillance with NST/BPP may be modified in setting of 101 COVID19 pandemic and the actual increased risk patients may face in coming into office for 30+ 102 minutes of testing. In general, we suggest the following principles: • There should be NO additional family/friend/partner in any outpatient appointment • Patients asked NOT to bring children • Visitor with symptoms at front desk check in WILL NOT be allowed in patient care areas and will be asked to return home.

• Patients may be asked to reschedule non-urgent care if they or their visitor are symptomatic

As well as Tracy Manuck

Gestational