Prenatal and Postnatal Care in the COVID-19 Context

No Results Found 0/0
The Prenatal and Postnatal Care in the COVID-19 Context tool is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: September 25, 2020
Last updated: October 21, 2020

Jump to the COVID-19 Resource Centre
Your one-stop shop for all of your COVID-19 related needs, including clinical guidance, maintaining regular primary care practice in the COVID-19 context, social care guidance, local services and more.

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of prenatal and postnatal care. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Key takeaway

Patients still require prenatal and postnatal visits. Given that there is a need to reduce number of visits, the timing, frequency and format (in-person vs. remote) of prenatal and postnatal visits can be adjusted. In circumstances where COVID-19 has caused service disruptions, patient refusal, and/or patient self-isolation, alternative strategies for prenatal and gestational diabetes screening should be implemented.

Click on the sections below to get started:

What's new, what's changed

Prenatal and postnatal care
Putting it into practice
  • At each visit, a responsible care provider must assess each woman to determine whether she is a candidate for an adjusted prenatal visit schedule as well as virtual care.
  • Post-partum visits can be done remotely.
Proposed schedule for low-risk prenatal visits

11-13 week visit

In-person

  • Combined dating/NT scan
  • Full history and risk assessment
  • Laboratory tests (including genetic screening) as needed

 
Tip: Can combine dating/NT to one ultrasound. There is a potential risk of being outside the window period for measuring NT if inaccurate dating by ‘Last Normal Menstrual Period.’ Earlier ultrasounds might also be needed for threatened abortion or if risk factors for an ectopic pregnancy etc. If completing initial prenatal blood work and a dating ultrasound prior to the first prenatal visit, this can be organized over the telephone.

16 week visit

Virtual/Telephone

  • Discuss screening and laboratory results
  • Initiate iron supplementation if needed
  • Book anatomy scan for next visit

20 week visit

In-person

  • Full anatomical scan
  • Give requisition for glucose challenge test and CBC, Ferritin and G&S (if RH negative)
  • G&S often needs to be done at lab no more than 4 weeks prior to administration of WinRho

26-28 week visit

In-person

  • Coincide with T2 bloodwork
  • If Rh negative, organize WinRho

 
Tip: For GCT, write on the requisition to allow the patient to wait in a car or in a private room in the clinic. If there are significant disruptions to lab testing and treatment due to COVID-19 and/or patient refusal, see Gestational diabetes mellitus screening.

30 week visit

Virtual/Telephone (as per AJOG MFM guideline):

  • Consider remote visit if appropriate
  • If remote: Review fetal movement and clinical signs of preterm labour and preeclampsia; patient to self-report BP (if accessible at home/pharmacy) and weight; consider self-symphysis fundal height3
  • Book BPP/growth ultrasound for 2 weeks (if indicated)
  • ADACEL

 
Tip: Can consider instructing patient on self-symphysis fundal height (SFH) measurement. Youtube video: How to measure your own fundus during pregnancy.

32 week visit

In-person

  • Routine prenatal care
  • BPP/growth ultrasound same day if indicated
  • ADACEL, if not given

34 week visit

Virtual/Telephone (as per AJOG MFM guideline):

  • Consider remote visit if appropriate
  • If remote: Review fetal movements and clinical signs of preterm labour and preeclampsia; patient to self-report BP (if accessible at home/pharmacy) and weight; consider self-symphysis fundal height

 
Tip: Can consider instructing patient on self-symphysis fundal height (SFH) measurement. Youtube video: How to measure your own fundus during pregnancy.

36 week visit

In-person

  • Routine prenatal care
  • GBS swab

 
Tip: If the 36-week visit is not in person, consider coordinating with the lab for the patient to drop off a GBS self-swab if possible. Instructions to provide patient.

37-38 week visit

In-person OR virtual/telephone:

  • If remote visit necessary: Review fetal movements and clinical signs of labour and preeclampsia; patient to self-report BP (if accessible at home/pharmacy) and weight
  • Instruction regarding GBS management in labour

39-41 week visit

In-person

  • Routine prenatal care
  • Stretch and sweep
  • Ultrasound as indication
Prenatal screening

The COVID-19 pandemic is having an impact on the delivery of prenatal screening services in Ontario:

  • Some diagnostic imaging centres are not offering dating and NT ultrasounds
  • Community blood collection services are being consolidated to a smaller number of labs
  • Pregnant individuals in self-isolation are missing the NT ultrasound window
Putting it into practice
  • Singletons: Order the second trimester MSS.
  • Twins: The MOH will temporarily fund NIPT for all twin pregnancies and can be ordered by any physicians or nurse practitioner (effective April 6, 2020-December 31, 2020).
  • Higher-order multiples: The only option continues to be an NT ultrasound.
Gestational diabetes mellitus (GDM) screening

The COVID-19 pandemic may cause severe disruptions to laboratory testing and treatment, and/or patient refusal for GDM screening.

Putting it into practice
  • All pregnant women without pre-existing diabetes will be screening with an A1c & non-fasting random plasma glucose:
    • A1c of < 5.7% and a random plasma glucose <11.1 mmol/L require to further testing or treatment.
    • A1c of >= 5.7% or a random plasma glucose of >= 11.1 mmol/L are identifies as having GDM.
  • Postpartum screening for maternal dysglycemia should be deferred until after the COVID-19 pandemic has ended. An in-person appointment solely for an oral glucose tolerance test (OGTT) is not recommended.

Resources New

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']