Clinical care of pregnant and postpartum women with COVID‐19: Living recommendations from the National COVID‐19 Clinical Evidence Taskforce

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID‐19 have been issued by the National COVID‐19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin‐to‐skin contact, breastfeeding, rooming‐in, antenatal corticosteroids, angiotensin‐converting enzyme inhibitors, disease‐modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real‐time to ensure clinicians in Australia have reliable, evidence‐based guidelines for clinical decision‐making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.

[1]  C. Tebé,et al.  A Cluster-Randomized Trial of Hydroxychloroquine as Prevention of Covid-19 Transmission and Disease , 2020, medRxiv.

[2]  L. Gresh,et al.  [An ethics call to include pregnant women in research: Reflections from the Global Forum on Bioethics in Research]. , 2017, Revista panamericana de salud publica = Pan American journal of public health.

[3]  J. Qu,et al.  Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial , 2020, BMJ.

[4]  Yimin Li,et al.  Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID‐19) infection , 2020, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[5]  Á. Avezum,et al.  Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19 , 2020, The New England journal of medicine.

[6]  Elie A Akl,et al.  SERIES: LIVING SYSTEMATIC REVIEWS Living systematic review: 1. Introduction d the why, what, when, and how , 2022 .

[7]  Inge Christoffer Olsen,et al.  A pragmatic randomized controlled trial reports lack of efficacy of hydroxychloroquine on coronavirus disease 2019 viral kinetics , 2020, Nature Communications.

[8]  J. P. Peña-Rosas,et al.  Transmission of SARS‐CoV‐2 through breast milk and breastfeeding: a living systematic review , 2020, Annals of the New York Academy of Sciences.

[9]  J. Thachil,et al.  COVID‐19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry—Communication from the ISTH SSC for Women’s Health , 2020, Journal of Thrombosis and Haemostasis.

[10]  C. Hsiao,et al.  A multicenter, randomized, open-label, controlled trial to evaluate the efficacy and tolerability of hydroxychloroquine and a retrospective study in adult patients with mild to moderate coronavirus disease 2019 (COVID-19) , 2020, medRxiv.

[11]  T. Hoffmann,et al.  Waste in covid-19 research , 2020, BMJ.

[12]  Xiang Chen,et al.  Efficacy and safety of chloroquine or hydroxychloroquine in moderate type of COVID-19: a prospective open-label randomized controlled study , 2020, medRxiv.

[13]  C. Sandoval.  Extracorporeal Membrane Oxygenation for Critically Ill Adults. , 2016, Critical care nurse.

[14]  P. Morris,et al.  Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. , 2014, Evidence-based child health : a Cochrane review journal.

[15]  J. Nates,et al.  Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19). , 2020, Obstetrics and gynecology.

[16]  L. Mofenson,et al.  Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis , 2020, BMJ.

[17]  Michele Tarsilla.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[18]  Kath Wright,et al.  PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours , 2019, PloS one.

[19]  S. Srinivas,et al.  Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study , 2020, American Journal of Obstetrics & Gynecology MFM.

[20]  A. Benachi,et al.  Transplacental transmission of SARS-CoV-2 infection , 2020, Nature Communications.

[21]  Lara A Kahale,et al.  Living systematic reviews: 4. Living guideline recommendations. , 2017, Journal of clinical epidemiology.

[22]  Christopher M Thomas,et al.  Successful Use of Extracorporeal Membrane Oxygenation Postpartum as Rescue Therapy in a Woman With COVID-19 , 2020, Journal of Cardiothoracic and Vascular Anesthesia.

[23]  P. Horby,et al.  A randomised trial of treatments to prevent death in patients hospitalised with COVID-19 (coronavirus) , 2020, http://isrctn.com/.

[24]  O. Tsang,et al.  Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. , 2020, JAMA.

[25]  Yi Wang,et al.  Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial , 2020, The Lancet.

[26]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[27]  D. Boulware,et al.  A Systematic Review of Treatment and Outcomes of Pregnant Women With COVID-19—A Call for Clinical Trials , 2020, Open forum infectious diseases.

[28]  S. Abd-Elsalam,et al.  Hydroxychloroquine in the Treatment of COVID-19: A Multicenter Randomized Controlled Study , 2020, The American journal of tropical medicine and hygiene.

[29]  J. Dorling,et al.  Maternal transmission of SARS‐COV‐2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis , 2020, BJOG : an international journal of obstetrics and gynaecology.

[30]  Mark Payne,et al.  Health and Human Services , 2020, Congress and the Nation 2013-2016, Volume XIV: Politics and Policy in the 113th and 114th Congresses.

[31]  A. Kotzeva,et al.  The validity of recommendations from clinical guidelines: a survival analysis , 2014, Canadian Medical Association Journal.

[32]  S. Walker,et al.  Consider pregnancy in COVID-19 therapeutic drug and vaccine trials , 2020, The Lancet.

[33]  L. Mandelbrot,et al.  Placental transfer and safety in pregnancy of medications under investigation to treat coronavirus disease 2019 , 2020, American Journal of Obstetrics & Gynecology MFM.

[34]  Julie Brown,et al.  Antenatal Corticosteroids for Accelerating Fetal Lung Maturation for Women at Risk of Preterm Birth , 2007, The Cochrane database of systematic reviews.

[35]  T. Turner,et al.  Breathing life into Australian diabetes clinical guidelines , 2020, The Medical journal of Australia.

[36]  ACOG Committee Opinion No. 646: Ethical Considerations for Including Women as Research Participants. , 2015, Obstetrics and gynecology.

[37]  Gordon H Guyatt,et al.  GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction , 2016, British Medical Journal.

[38]  S. Ricketts,et al.  Hospital practices that increase breastfeeding duration: results from a population-based study. , 2007, Birth.

[39]  L. Dodd,et al.  Remdesivir for the Treatment of Covid-19 — Final Report , 2020, The New England journal of medicine.

[40]  R. Bruno,et al.  Remdesivir for 5 or 10 Days in Patients with Severe Covid-19 , 2020, The New England journal of medicine.

[41]  Christopher M. Horvat,et al.  Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. , 2020, JAMA.

[42]  Lidia Ruiz,et al.  Hydroxychloroquine for Early Treatment of Adults with Mild Covid-19: A Randomized-Controlled Trial , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[43]  B. Hunt,et al.  A critical review of the pathophysiology of thrombotic complications and clinical practice recommendations for thromboprophylaxis in pregnant patients with COVID‐19 , 2020, Acta obstetricia et gynecologica Scandinavica.

[44]  L. Riley,et al.  Putting It All Together: Clinical Considerations in the Care of Critically Ill Obstetric Patients with COVID-19 , 2020, American Journal of Perinatology.

[45]  Jennifer L. Bell,et al.  Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial. , 2020, medRxiv.

[46]  Hongzhou Lu,et al.  [A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19]. , 2020, Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences.

[47]  S. Rasmussen,et al.  Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know , 2020, American Journal of Obstetrics and Gynecology.

[48]  D. Musso,et al.  2019-nCoV epidemic: what about pregnancies? , 2020, The Lancet.

[49]  J. Beca,et al.  Un llamado ético a la inclusión de mujeres embarazadas en investigación: Reflexiones del Foro Global de Bioética en Investigación , 2017, Revista panamericana de salud publica = Pan American journal of public health.

[50]  Zhan Zhang,et al.  Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial , 2020, medRxiv.

[51]  P. Langhorne,et al.  Bringing stroke clinical guidelines to life , 2019, International journal of stroke : official journal of the International Stroke Society.

[52]  S. Vohra,et al.  Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. , 2018, The Cochrane database of systematic reviews.

[53]  P. Shekelle,et al.  Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? , 2001, JAMA.

[54]  Susan L Norris,et al.  Developing and applying a 'living guidelines' approach to WHO recommendations on maternal and perinatal health , 2019, BMJ Global Health.

[55]  A. Parow,et al.  Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study , 2020, The Lancet Child & Adolescent Health.

[56]  Emily G McDonald,et al.  A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 , 2020, The New England journal of medicine.

[57]  A. Sudlow,et al.  Prone position for acute respiratory failure in adults. , 2015, The Cochrane database of systematic reviews.

[58]  M. Giles,et al.  COVID‐19 and pregnancy: A review of clinical characteristics, obstetric outcomes and vertical transmission , 2020, The Australian & New Zealand journal of obstetrics & gynaecology.

[59]  Carmel Collins.  World Health Organization. Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. , 2017 .

[60]  Emily Fraser.  Long term respiratory complications of covid-19 , 2020, BMJ.

[61]  Bruno Luís de Castro Araujo.  Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 , 2021, Annals of Internal Medicine.

[62]  S. Vohra,et al.  Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. , 2010, The Cochrane database of systematic reviews.

[63]  Nancy Medley,et al.  Early skin-to-skin contact for mothers and their healthy newborn infants. , 2013, The Cochrane database of systematic reviews.

[64]  P. Tugwell,et al.  AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both , 2017, British Medical Journal.

[65]  Geraldine Mc Loughlin.  Rooming‐in for new mother and infant versus separate care for increasing the duration of breastfeeding , 2018, International journal of nursing practice.

[66]  L. Duley,et al.  Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. , 2019, The Cochrane database of systematic reviews.

[67]  Inge Christoffer Olsen,et al.  A pragmatic randomized controlled trial reports lack of efficacy of hydroxychloroquine on coronavirus disease 2019 viral kinetics , 2020, Nature Communications.

[68]  Jennifer L. Bell,et al.  Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report , 2020, medRxiv.