I just tested positive for COVID-19 and I’m pregnant! Now WHAT?!?!

With rising COVID19 cases in New Hampshire, we are getting calls daily from our patients reporting a positive COVID-19 test.  We are here to support you with the latest information about pregnancy and COVID19.  We know that you are worried and have lot’s of questions.  We are updating this information as new guidance becomes available.

If you think you may have symptoms of COVID19, you should be tested.  Symptoms include: cough, fever, shortness of breath, headache, cold-like symptoms, sore throat, or loss or change to your sense of smell or taste.  There are many options for testing including at-home test kits (only should be done if you are symptomatic), state test sites, and pharmacies.  For a full list of testing sites, click here.  New Hampshire is also offering free COVID19 test kits.  To get your test kit, follow this link.

If you test positive for COVID-19, please call us during office hours at 603-668-8400 to let us know.  For the safety of our patients and team members, your next visit will be scheduled at least 10 days from the date of your positive test.  We are also happy to convert your scheduled visit to a telehealth visit to check-in with you.  You should isolate from others and stay at home for 10 days.  If you live with unvaccinated family members, try to isolate yourself from them.  If you are unable to isolate yourself, those family members also need to quarantine – they will need to quarantine for 20 days.  If you do need to leave your house for medical care, please be sure to wear a mask and call your healthcare provider before you arrive to notify them of your positive COVID-19 test result.

Most cases of COVID-19 are mild and can be managed at home with getting plenty of fluids and rest, as well as using medication to reduce a fever.  It is safe to treat a fever in pregnancy with Tylenol (Acetaminophen) 1000mg every eight hours.  In addition, make sure you’re staying hydrated by drinking a lot of water.  If you are fully vaccinated for COVID-19, your risk of severe illness is significantly less than those who are not vaccinated.

Primary care providers are well versed in the symptoms of COVID-19 and recommendations for treatment.  We would encourage you to reach out to your primary care provider for additional recommendations.  Because pregnancy is considered to be a high risk condition for COVID-19, your primary care provider may recommend that you receive monoclonal antibodies.  Monoclonal antibody treatments are recommended by the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) for treatment of pregnant people with mild to moderate COVID-19 who are at risk for complications from COVID-19.  There is a limited supply of monoclonal antibodies so we are relying on insight from your primary care provider as to whether you should receive monoclonal antibodies based on your symptoms.  Although monoclonal antibodies have not been specifically evaluated in pregnancy, preliminary data suggests that monoclonal antibody treatment is safe in pregnancy.  Orders for monoclonal antibodies need to come from your primary care provider.

If you feel like your symptoms are worsening, please reach out to your primary care provider for additional recommendations.  Watch for emergency warning signs for COVID-19 which may indicate more severe illness including difficulty breathing, confusion, persistent pain or pressure in the chest, or pale, gray, or blue-colored skin, lips or nail beds.  If you have any of these signs, seek emergency medical care immediately.

According to the data available from the CDC and ACOG, people with COVID-19 during pregnancy are more likely to experience preterm birth (delivering the baby earlier than 37 weeks) and stillbirth and might be more likely to have other pregnancy complications compared to people without COVID-19 during pregnancy.  Unfortunately, there are not any specific ways to prevent these risks once someone tests positive for COVID-19 other than monitoring for symptoms.  Due to a risk of pre-eclampsia (high blood pressures in pregnancy), if you are less than 28 weeks pregnant, you should begin taking low dose aspirin (81mg) daily starting at 12 weeks of pregnancy, if you have not already been instructed to take aspirin.  If you’re more than 28 weeks pregnant, you do not need to start aspirin.  If you’ve already been on it, continue taking your aspirin until you deliver.

If you were hospitalized with COVID-19, we will schedule non-stress tests to monitor your baby’s well-being twice weekly starting at 32 weeks (and at least 14 days after you were diagnosed with COVID-19) and an ultrasound to check your baby’s growth.  Please reach out to our office with any symptoms of preterm labor which include: Regular, frequent contractions or tightening of your belly, leaking fluid like your water might have broke, worsening lower back pain, and a sensation of significant lower pelvic pressure.

If you have not already received your COVID-19 vaccine or booster, once you are feeling better and it’s been at least 14 days since you were diagnosed with COVID-19, please get vaccinated.  Even if you have already had COVID-19, vaccination is still the best way to protect you and your baby.  

We hope you feel better soon.  Again, please be sure to seek emergency medical help if you are having any severe symptoms of COVID-19.

For more information, please visit: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html

Travel in Pregnancy

Travel During Pregnancy
In most cases, pregnant women can travel safely until close to their due dates. Please discuss your travel plans with your OB-GYN for specific recommendations. Some considerations:

COVID
Delay travel until you are fully vaccinated. If you are not fully vaccinated and must travel, follow the CDC guidelines at www.cdc.gov.

Risk of Blood Clots
DVT (deep venous thrombosis) is a condition in which a blood clot forms in the veins, usually in the leg. DVT can lead to a dangerous condition called pulmonary embolism. This is when a blood clot travels to the lungs. Research shows that any type of travel lasting 4 hours or more—whether by car, train, bus, or plane—doubles the risk of DVT. Being pregnant is an extra risk factor for DVT. If you are planning a long trip, take the following steps to reduce your risk of DVT:

  • Drink lots of fluids without caffeine.
  • Wear loose-fitting clothing.
  • Walk and stretch at regular intervals.
  • Special stockings that compress the legs, either below the knee or full length, also can be worn to help prevent blood clots from forming.
  • Take 81mg of aspirin (also called low-dose aspirin) once prior to travel if you are not already taking daily aspirin for other indications.


Travel by Plane

  • Generally safe during pregnancy. Most airlines allow travel until 36 weeks.
  • Consider international travel plans in the third trimester of pregnancy. Depending on where you are planning to go, you may want to delay travel until after delivery based on the healthcare resources available where you are traveling.

Zika

  • Can be found throughout the world and is transmitted by a mosquito
  • Babies born to women infected with Zika are at increased risk for birth defects, especially microcephaly (small head and brain)
  • There is no vaccine or treatment for Zika. Avoidance of mosquito bites in active areas is the best protection. Discuss with your doctor if you will be traveling out of the country.
  • Visit www.cdc.gov/zika for the most updated guidelines.

 

Coronavirus (COVID-19) Updates: What Are We Doing to Keep You Healthy

As COVID-19 continues to be a concern in the United States, we want to remind our patients what we are doing to make sure you have a safe experience in our office.  We have received very positive feedback from our patients who have been to our office recently and we continue to make changes regularly.

Here is a little about what we are doing:

  • Contact-less paperwork – Patients will receive paperwork via text message 3 days prior to their appointments.  Completing the forms online prevents exchange of papers at check-in.  You can even take a photo of your insurance card and securely send it to us as well as pay your co-pay.
  • Masks will be worn by all Bedford Commons team members and patients.  Although the mask mandate has been lifted in NH, Bedford Commons will continue to require masks for all patients and team members in the building. Masks are NOT optional – they are required.
  • Screening – All patients (and accompanying visitors) presenting to our office for a visit will answer a series of questions before entering our building to assess COVID-19 risk.  Our Bedford Commons team members are also screened daily.
  • COVID-19 vaccinations – We have required all of our team members to be vaccinated for COVID-19.  Although we are unable to offer COVID-19 vaccines in our office, we encourage all of our patients to receive the COVID-19 vaccine.
  • Wait in your car – In our Bedford location only, our patients can check-in and wait in their cars instead of in our waiting room.  If it’s easier for you to check in at our front desk, come on in through Door 2 when you arrive.  For our Windham and Derry locations, patients will be brought right back into an exam room.
  • Telehealth visits – If you feel uncomfortable coming into our office for a visit, we are happy to virtually see you with a telehealth visit.

Our goal as a practice is to continue to provide you with exceptional care while keeping you safe.  We are all in this together.

For our OB patients and families:

Bedford Commons OB-GYN has adopted an alternative schedule for obstetric visits in our office based off guidance from the American College of Obstetricians and Gynecologists (ACOG) to limit your exposure risk to COVID-19.  Instead of seeing our obstetric patients every four weeks through the end of the second trimester, most visits were scheduled 6-8 weeks apart.  Starting in the third trimester, we were seeing our patients every 2-4 weeks depending on risk factors.

As we have watched the COVID-19 pandemic unfold, it is clear that we will be coexisting with COVID-19 for the months ahead.  Several of our patients have asked if we will be continuing the alternative schedule for obstetric care or if we will resume the “normal” frequency of visits.  For at least the next few months, we plan on continuing to see our OB patients at a more spaced out interval.  Here’s what a typical visit schedule might look like:

  •           8 weeks visit
  •           11-12.5 weeks ultrasound* and visit (*if you’ve already had an ultrasound in your pregnancy, an ultrasound will not be planned with this visit)
  •           16 week visit
  •           20 week anatomy ultrasound and visit
  •           24 week visit
  •           28 week visit and glucose testing
  •           32 week visit
  •           36 week visit and group B strep (GBS) testing
  •           37 week visit
  •           38 week visit
  •           39 week visit
  •           40 week visit (your due date!)

At Bedford Commons OB-GYN, we believe that every woman is an individual.  It’s important to us that you feel comfortable and confident in the care you are receiving.  Although we feel that it is safe to continue more spaced out OB visits, we know that some of our patients would feel more reassured seeing us a little more often.  If you would like to see us more frequently, just let us know at your visit.  Additionally, some of our patients have risk factors or concerns that may necessitate additional visits.  We will let you know if we need to see you more often.

As of January 3, 2022, one adult visitor may accompany you to your ultrasounds; visitors will not be permitted at office visits.  We know what an important journey pregnancy is for an expecting family but for the safety of all of our patients, we can only permit one visitor at ultrasound visits only.  We hope to again return to having visitors for routine visits but need to see a reduction in COVID-19 positive cases in NH.

Some of our patients have also been asking about the safety of the COVID-19 vaccine in pregnancy.  We strongly encourage all of our patients to receive the COVID-19 vaccine, especially those who are pregnant.  Pregnancy significantly increases the risks associated with COVID-19 illness and vaccination is the best way to protect you and your baby.  Click here for more information.

 

COVID-19 Visitor Policy Update

We are pleased to share that due to low community transmission rates in our area, we are no longer restricting visitors to our office.  Like always, children accompanying you to your visits need to be supervised at all times.  We look forward to seeing you!

We continue to follow CDC and NH state guidance regarding COVID-19 precautions.  Bedford Commons OBGYN continues to require masks for all patients and team members.  If you have any questions or concerns, please reach out to our office.

Special request from Bedford Commons OB-GYN – Please get vaccinated!

As you probably are aware, we are seeing a dramatic surge in COVID-19 cases.  After two years of providing healthcare in this new environment, many of us are exhausted; we are sure you are exhausted too.

This is our special request – please get vaccinated. 

With the rising COVID-19 cases in New Hampshire, we unfortunately have seen some of the sad outcomes that can occur with COVID-19.  We have witnessed firsthand the devastating effects of severe COVID-19 in pregnancy, seeing our patients hospitalized, some required ICU care, long term oxygen supplementation, and all of whom were in fear of harm to their baby.  Compared to those who aren’t pregnant, pregnant women infected by COVID-19 with symptoms are 3 times more likely to need ICU care, 2 to 3 times more likely to need advanced life support and have a 70% increased risk of death.  Severe COVID-19 can also cause issues for babies including a 60% increased risk of very premature birth, extended stays in the neonatal ICU, and risk of stillbirth.  All major medical organizations and we, your doctors, feel that COVID-19 vaccination in pregnancy is very safe and critically important because pregnancy is considered a high-risk condition for severe illness with COVID-19.

If you’re pregnant, get vaccinated as soon as possible.  We get calls daily from unvaccinated pregnant women who recently tested positive for COVID-19, asking us how they can prevent complications from COVID-19.  Unfortunately, there really isn’t anything that can be done once someone has COVID-19 other than monitor symptoms and treat a fever.  The only way to prevent complications from COVID-19 is vaccination.

If you’re not pregnant, make sure you get a COVID-19 vaccine and talk to friends and family members who are pregnant and encourage them to get vaccinated.  If you’re already vaccinated, thank you.  Be sure to also get your booster dose.

We know that everyone is really tired of this.  Please do your part and get vaccinated.

We care deeply about you so please, let’s work together to keep each other safe.

COVID19 Vaccine Considerations for Pregnant or Breastfeeding Women

Many of our patients have been asking about the safety and effectiveness of the COVID19 vaccine in pregnancy and breastfeeding.  Vaccination is the best way to reduce the risks of COVID-19 infection and COVID-related complications for both you and your baby.  Now that the vaccine has been out since December 2020, we have a lot more information about the vaccine for pregnant and breastfeeding women.

Both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommend that pregnant and breastfeeding people be vaccinated against COVID19.  The Society for Maternal-Fetal Medicine has issued a statement with some guidance to women who are currently pregnant, planning pregnancy, or breastfeeding who are considering the COVID19 vaccine.  Click here to read the article.

Although pregnant or lactating women were not included in the COVID19 vaccine clinical trials, at this time more than 177,000 pregnant people have been vaccinated and no unexpected pregnancy or fetal problems have occurred.  There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects.

We know that about 1 to 3 in 1,000 pregnant women with COVID19 will develop severe illness.  Compared to those who aren’t pregnant, pregnant women infected by COVID19 with symptoms are 3 times more likely to need ICU care, 2 to 3 times more likely to need advanced life support, and have a 70% increased risk of death.  According to a September 29, 2021 urgent health advisory from the Centers for Disease Control (CDC), there have been more than 125,000 confirmed cases of COVID19 in pregnant people including more than 22,000 hospitalizations and 161 deaths.  To reduce these risk, the COVID19 vaccine is recommended.  See the full CDC health advisory here.  

With the rising COVID-19 cases in New Hampshire, we unfortunately have seen some of the sad outcomes that can occur with COVID-19 in pregnancy.  We get calls daily from unvaccinated pregnant women who recently tested positive for COVID-19, asking us how they can prevent complications from COVID-19.  Unfortunately, there really isn’t anything that can be done once someone has COVID-19 other than monitor symptoms and treat a fever.  The best way to prevent complications from COVID-19 is vaccination.

We strongly recommend that our pregnant and breastfeeding patients get the COVID19 vaccinationPregnancy is not an indication for a COVID19 vaccine waiver.  

If you have questions about the vaccine, please talk to your provider at your next visit.

COVID Vaccine Boosters – Do I need one?

The short answer is YES.  As of November 29th, 2021, the U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone ages 18 and older should get a booster dose.  

If you received Pfizer-BioNTech or Moderna vaccines: You should get a booster at least 6 months after completing your primary COVID-19 vaccination series.
If you received the Janssen (J&J) vaccine: You should get a booster 2 months after completing your primary COVID-19 vaccination.

Which booster should you get?
You may choose which COVID-19 vaccine you receive as a booster shot.  Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster.  CDC’s recommendations now allow for this type of mix and max dosing for booster shots.

For any adults 18 years old or older who completed their primary Pfizer-BioNTech or Moderna vaccine series at least 6 months ago OR received the Janssen (J&J) vaccine at least 2 months ago, a booster dose of the COVID-19 vaccine is recommened.

Where can I get a booster?  Although we are not giving COVID19 boosters at Bedford Commons OBGYN, if you are eligible for a booster dose, you can schedule an appointment at any retail pharmacy or can inquire about an additional dose through your primary care provider office.  Find a vaccine location by clicking here: https://www.vaccines.gov/.  If you haven’t gotten a flu shot this year, consider getting the flu vaccination along with your COVID19 booster.  Both can be given on the same day.

What about boosters in pregnancy?  We strongly recommend that our pregnant patients receive the COVID-19 vaccine and also strongly recommend the COVID-19 booster for our pregnant patients who qualify.  For more information about the COVID19 vaccine and pregnancy, click here.

What is a DO?

Throughout my training and career, this question has certainly come up more than once. Now, more than ever, with the topic of DO physicians making news and headlines (all press is good press, right? Not necessarily…) are we presented with the opportunity to educate and share exactly what “DOing” is.

DO stands for Doctor of Osteopathic Medicine whereas MD stands for Doctor of Medicine.  Like MDs, Doctors of Osteopathic Medicine are fully licensed physicians who can practice in all areas and specialties of medicine.  We practice evidence-based medicine, using the latest science and technology.  During our medical school training, like MD students, the first two years are centered around classroom learning, and the last two gaining clinical experience in various specialties during clinical rotations.

Many DOs sit for the same licensing exams as MDs (USMLE) during medical school in addition to their osteopathic licensing exams (COMLEX).  The field has grown 300% (wow!) in the last three decades, currently making up 11% of the physician population.  In addition, 42% of actively practicing DOs are female!

In many circumstances, patients may not even notice a difference between their DO or MD physicians.  Where DOs differ is the underlying philosophy that is incorporated in our medical school training.

The hallmark of Osteopathy emphasizes a “whole person” approach (a person is a unit of “body, mind and spirit”).  We are trained that the person and body is whole and interconnected, and each body system affects the other.  DOs have an additional 200 hours on top of general medical school curriculum that focuses on Osteopathic Manipulative Treatment (OMT).  OMT is a hands-on approach, where we learn in depth musculoskeletal exam and treatment of musculoskeletal dysfunction, which may be related to visceral (other body systems/organs) or somatic (musculoskeletal) causes.  While not every DO uses OMT in their day to day practice, this inherent philosophy of treating the person as a whole is how osteopaths are trained to approach each and every patient.  Many of my MD colleagues approach their patients with a similar view due to their compassionate personality, but this philosophy is not part a focus their medical school curriculum.

One of the best parts of being a DO, like all differences, is being able to bring a different perspective to the table.  I am proud of my training and where it has led me (here at BCOG!)!