Guidelines For The Management of Pregnant Women and Nursing Mothers

COVID-19
FEDERAL MINISTRY OF HEALTH
Guidelines for the

Management of
Pregnant Women
and Nursing Mothers
NCDC Toll-free Number: 080097000010 SMS: 0809 955 5577 WhatsApp: 0708 711 0839
@NCDCgov covid19.ncdc.gov.ng [email protected] @NCDCgov
Guidelines for the Management of Pregnant Women and Nursing Mothers
Throughout the gestational period, it is important for obstetric health care

facilities to strengthen health counselling, screening, and follow-ups for
pregnant women, while incorporating screening, hand hygiene practice,
good respiratory etiquette and infection prevention control precautions.
These screening procedures will help determine individualised precautions
necessary, such as the wearing of face masks during consultations.
Screening characteristics to be
considered may include:
• Symptoms of influenza-like illness such as fever, cough, difficulty breathing,
shortness of breath and other cold/flu symptoms
• Usual rapid assessment including airway, breathing, circulation, vaginal
bleeding,
• Level of consciousness, convulsions, fever, and abdominal pain should be
considered
• Having travelled to an area where the virus is known to be circulating,
and/or travel outside Nigeria within the last 14 days
• Having been in close contact with a probable or confirmed case of
COVID-19 or someone who has travelled to an affected area
• All individuals (patients, employees, visitors, delivery personnel), on entry
to a health care facility, should perform hand hygiene
• Individuals with respiratory symptoms, of any cause, should wear a face
mask
• For patient information, a diagram of how to apply and remove masks
might be helpful to post with masks (e.g. the diagram below from the Centre
for Disease Control). COVID-19 test process is the same for pregnant and
non-pregnant women and is based on local public health policies
2 SOURCE: https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
Care for all expectant mothers

• Provide counseling related to risk of adverse pregnancy outcomes,
safe infant feeding, self-care, postnatal care, and appropriate infection
prevention and control (IPC) to prevent COVID-19 transmission
Provide
• Identify high risk pregnancies for ANC and modify schedule and give pre-
counseling
related to risk appointments to come to health facilities to reduce crowding and maintain
of adverse
pregnancy physical distancing
outcomes,
safe infant
feeding, • Handwashing facilities and soap should be made available for all
self-care,
postnatal expectant mothers visiting health facilities. Alcohol-based sanitisers should
care and IPC
also be available
• Consider delay in routine appointments. Creative approaches to

appointments may be considered such as phone consultations to avoid
unnecessary travel to health facilities.
• Create a special, isolated and highly hygienic room for pregnant women
and nursing mothers for ante-natal care visits and post-natal care visits
respectively
• Appointments should be spaced out to avoid overcrowding in health

facilities, and within waiting rooms physical distance should be ensured
between patients.
• Reinforcing visit time and procedures in obstetric clinics and units with
specialised infection control preparations and protective clothing
3
Expectant mothers with suspected or

confirmed COVID-19
It is important to remember all patients, regardless of COVID-19 status, should
continue to monitor for any concerning maternal and/or foetal signs (e.g.
foetal movement counting).
• In women affected by COVID-19 with ongoing pregnancy, surveillance

for fetal growth restriction would be reasonable, given the acute and
chronic placental changes observed in a recent study
• Because 47% of reported cases of COVID-19 among pregnant women

had preterm delivery, women will need to be monitored locally in their
maternity units with transfer for delivery to centres with appropriate
neonatal intensive care facilities for delivery
47%
• Discuss balance of benefits and harms of corticosteroids with the woman
to ensure informed decision. WHO recommends antenatal corticosteroid
of reported
cases of
therapy for women at risk of preterm birth from 24 to 34 weeks of gestation
COVID-19 when there is no clinical evidence of maternal chorioamnionitis, gestational
among
pregnant age is reliable, and adequate childbirth and newborn care is available
women had
preterm • Mask and separate patient with signs of COVID-19 (minimum 2 metre
delivery
between suspected and other patients); engage response team including
infection prevention and control (IPC) staff.
• Antepartum foetal surveillance should occur as part of scheduled routine

care
• If a person and/or their support person becomes symptomatic at home,

they should be directed to call their local public health unit
4
• If a person and/or their support person presents for care and screens
positive on any of the characteristics mentioned in screening, it is
recommended to:
o Triage quickly
o Give them a mask to wear (N95 are not recommended)
o Place the individual in a single occupancy waiting area or room (e.g.

clinic, triage or labour room with a door
o Do not cohort with other patients
• Use droplet/contact precautions for health care providers, including

wearing a procedure/surgical mask with eye protection
o In accordance with hospital guidelines, use of an N95 mask (respirator)

is recommended in aerosol generating situations such as intubation
• Obstetrical care providers may consider delay of Elective Caesarean, if

possible, until a patient is asymptomatic
• Decision for Caesarean Birth is based on maternal-foetal status as per

obstetrical recommendations
• Access clinical risks for serious complications of COVID-19 comorbidities

including hypertension; diabetes; asthma; HIV; TB, heart, liver, lung,
kidney, or blood disease; immune suppression
18
UNDER
Visitors
• Limit visitors to only 1 person per patient. This may be the pregnant person’s
partner or designated family member
• Children under the age of 18 may be limited from visiting within the
hospital at any time
5
• Any family member who is symptomatic, has had close contact with a
potential COVID-19 patient, travelled outside Nigeria within the last 14
days, and/ or other risks factors should self-quarantine for 14 days
• Patient waiting rooms, and common rooms may be closed
• It is advisable to limit the presence of non-symptomatic family and

household contacts in the waiting areas, and visitation post-delivery should
Use video
be permitted in accordance with locally developed infection prevention
conferencing
apps as and control protocols
alternatives
for
• Use of technology such as video conferencing applications (e.g. Skype,
connections
with family ZOOM, or Facetime) could be used as alternatives for connections with
and support
persons family and support persons
Neonatal Care
If a person was COVID-19 positive, the new-born should be tested for
COVID-19 at birth (i.e., nasopharyngeal swab and umbilical swab). If the
mother was not tested but suspected of being COVID-19 positive, consider
testing of the neonate.
Universal isolation of the infant from either confirmed or suspected infection

in the mother is not recommended. However, depending on availability
of resources the infant may be separated the from mother until isolation
precautions for the mother can be formally discontinued.
Based on available evidence, continue with:
• Skin to skin contact with mother after mother completes hand hygiene
o If the mother is symptomatic, she should also wear a mask

6
• Bathing baby as per facility practice
• Breastfeeding is encouraged and supported:
o For breastfeeding mothers: considering the benefits of breastfeeding and

the insignificant role of breast milk in transmission of other respiratory
viruses, breastfeeding can continue. If the breastfeeding mother is a
case, she should wear a surgical/procedure mask when near the baby,
practice good respiratory hygiene, and perform hand hygiene before
and after close contact with the baby
• Maintain immunisation schedules
All those providing infant care (individuals, family and staff) should practice
hand hygiene before and after care. Use of a mask according to facility
guidelines and presence of symptoms in newborn.
Postnatal care
• Prioritise first contact (within 24 hours of delivery) with adequate Infection
Prevention Control measures.
• Replace subsequent contacts in no-risk cases with home-visits (where

possible), tele-consultation and counselling.
Referral and Emergency Transport

Use separate
• Provide emergency transport from home and lower level health facilities to
transport
vehicles for higher level facilities and back to home with clear referral pathway.
COVID-19
negative cases
• Separate transport vehicles and personnel are recommended for COVID-19
and COVID-19
suspected and negative cases and COVID-19 suspected and confirmed cases.
confirmed cases
7
Provision sexual and reproductive

health services
• Designate units with enhanced IPC provisions, triage and isolation areas
for COVID-19 suspected or positive cases to sustain provision of safe and
quality services for family planning, safe delivery and management of
potential complications (CEmONC), abortion care, and referral care for
serious diseases.
For more information for health care professionals on the management

of coronavirus (COVID-19) in pregnancy, visit the SOGON website
www.sogon.org
Be aware that media speculation is rife about COVID-19 and not everything
you read in the newspapers or online or hear is accurate or verified. The
release of trusted and accurate information will always be released by the
Ministry of Health or Nigeria Centre for Disease Control.
You can find the latest information and advice by contacting NCDC on:
• NCDC Toll-free Number: 0800-9700 0010
• Website for additional resources:
https://covid19.ncdc.gov.ng/guidelines.php
• Twitter and Facebook: @NCDCgov
Partner support from :

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COVID-19

FEDERAL MINISTRY OF HEALTH

Guidelines for the

Guidelines for the Management of Pregnant Women and Nursing Mothers

Throughout the gestational period, it is important for obstetric health care

Guidelines for the Management of Pregnant Women and Nursing Mothers

Care for all expectant mothers

• Consider delay in routine appointments. Creative approaches to

• Appointments should be spaced out to avoid overcrowding in health

Guidelines for the Management of Pregnant Women and Nursing Mothers

Expectant mothers with suspected or

• In women affected by COVID-19 with ongoing pregnancy, surveillance

• Because 47% of reported cases of COVID-19 among pregnant women

• Antepartum foetal surveillance should occur as part of scheduled routine

• If a person and/or their support person becomes symptomatic at home,

Guidelines for the Management of Pregnant Women and Nursing Mothers

o Give them a mask to wear (N95 are not recommended)

o Place the individual in a single occupancy waiting area or room (e.g.

o Do not cohort with other patients

• Use droplet/contact precautions for health care providers, including

o In accordance with hospital guidelines, use of an N95 mask (respirator)

• Obstetrical care providers may consider delay of Elective Caesarean, if

• Decision for Caesarean Birth is based on maternal-foetal status as per

• Access clinical risks for serious complications of COVID-19 comorbidities

Guidelines for the Management of Pregnant Women and Nursing Mothers

• Patient waiting rooms, and common rooms may be closed

• It is advisable to limit the presence of non-symptomatic family and

Universal isolation of the infant from either confirmed or suspected infection

Based on available evidence, continue with:

o If the mother is symptomatic, she should also wear a mask

Guidelines for the Management of Pregnant Women and Nursing Mothers

• Bathing baby as per facility practice

• Breastfeeding is encouraged and supported:

o For breastfeeding mothers: considering the benefits of breastfeeding and

• Maintain immunisation schedules

• Replace subsequent contacts in no-risk cases with home-visits (where

Referral and Emergency Transport

Guidelines for the Management of Pregnant Women and Nursing Mothers

Provision sexual and reproductive

For more information for health care professionals on the management

• NCDC Toll-free Number: 0800-9700 0010

• Website for additional resources:

• Twitter and Facebook: @NCDCgov

Partner support from :

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