PREGNANT Asymptomatic patients with
positive COVID-19 Disease

Note: The current recommended treatment is based on limited available information from current clinical data (Case-reports, published literature, Limited guidelines and expert opinion, Communicable disease Center-Qatar, CDC-USA, Up-to-date, Medscape), Internet book of critical care.

General Measures
  1. This treatment protocol is to assist physicians in management of patients with confirmed COVID-19 infection patients in order to guide the healthcare professionals.
  2. All therapies to the confirmed COVID-19 should be given with strict infection control measures as per your local needs
  3. Samples (Both Oral/Nasal-Swabs) should be collected in negative pressure room (if not available single room with HEPA FILTERS)
  4. All healthcare staff should wear the full personal protective equipment PPE (Guan, gloves, N95 mask, face shield, eye protection whilst dealing with suspected/confirmed patients.
  5. All patients who are positive-COVID19, there swabs/PCR be repeated every 4-days till the test become negative.
  6. If the test of a suspected patient is negative for - COVID 19, then repeat after 24 hours.
  7. If 2 consecutive tests are negative, Isolation can be discontinued
    1. Lower respiratory specimen is preferred when applicable
    2. Airborne / contact isolation is recommended
    3. Confirmed cases can be kept in same large room, if shortage of single isolation rooms
    4. keep in touch with your local Infection Control Team and follow their guidance.
  8. All patient should have their CBC, Urea & Electrolytes, CRP, Chest X-ray, Respiratory panel including COVID-19 PCR as a baseline investigation.
  9. Request G6PD level (as it may affect some of the medications given)
  10. Electrocardiogram (ECG), for all patients above 40 years of age.
  11. On clinical needs, request Bronchoscopy, CT Chest (if clinically indicated)
  12. Consider QuantiFERON test for patient whom will be started on Tocilizumab.
Supportive therapy and monitoring
  1. No evidence linking NSAIDS to COVID-related clinical deterioration. This has not been proven clinically to date, so we cannot make a recommendation for or against their use at this time.
  2. American Heart Association, the Heart Failure Society of America and the American College of Cardiology all recommend that ACE inhibitors or ARBs be continued in people who have an indication for these medications We do not currently routinely recommend stopping these agents
  3. All patients with COVID-19 should receive standard prophylactic anticoagulation with LMWH/ Unfractionated heparin if no contraindications
  4. Continue statins if already prescribed where no contraindications and to prescribe it for those for those whom it is indicated
  5. Postexposure Prophylaxis for Healthcare Workers: There is currently no proven role for post exposure prophylaxis for people with a known COVID-19 exposure. They should follow self-quarantine for 14-days and monitor for symptoms.
  6. Monitor for drug -drug interactions (consult with your clinical pharmacist)
  7. Give supplemental oxygen therapy immediately to patients with COVID-19 and respiratory distress, hypoxemia, or shock. Initiate oxygen therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90% in non-pregnant adults and SpO2 ≥92-95 % in pregnant patients.
  8. All areas where patients with COVID-19 are cared for should be equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal cannula, simple face mask, and mask with reservoir bag). Use contact precautions when handling contaminated oxygen interfaces of patients with COVID-19 infection.
  9. Use conservative fluid management in patients with COVID-19 when there is no evidence of shock.
  10. Give empiric antimicrobials to treat all likely pathogens causing secondary bacterial infection in COVID-19 patients. Give antimicrobials within one hour of initial patient assessment for patients with sepsis.
  11. Do not routinely give systemic corticosteroids for treatment of viral pneumonia or ARDS unless they are indicated for another reason.
  12. Closely monitor patients with COVID-19 for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis, and apply supportive care interventions immediately.
  13. Understand the patient’s co-morbid condition(s) to tailor the management of critical illness and appreciate the prognosis. Communicate early with patient and family.
  14. Discharged patients will be kept in Home isolation /Quarantine for 4 weeks from the first positive COVID-result or 2 weeks after the last negative swab (whichever is longer).
Patients with no risks for severe disease
  1. Admit the patient for observation to the quarantine facility
    OR
  2. Regular review by Obstetrician.
  3. Isolation at home (as per local guidance)
  4. No treatment is recommended
  5. Strict infection control measures should be maintained all the time.
Patients with risks for severe disease
  1. Admit the patient Hospital/Quarantine Facility
  2. Regular review by Obstetrician.
  3. Chloroquine phosphate 250 mg (150 mg base )300 mg (base) BID
    for 5-days OR
  4. Hydroxy Chloroquine 400 mg OD, Orally for 5-days
    PLUS
  5. Azithromycin 500mg OD, Orally for 5-Days
* Risk factors for severe disease
  1. Old age pregnancy
  2. Patients with chronic medical conditions including:
    1. Cardiovascular disease
    2. Diabetes
    3. Chronic Lung disease
    4. Cancer patients
    5. Chronic kidney disease
  3. Immune suppressed patients


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