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), urgent care, or through your primary care provider.

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 5 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 5 days.

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.  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

Miscarriage is sadly incredibly common, occurring in approximately 10% of all pregnancies in the first trimester. It most often occurs due to an abnormal number of chromosomes in the developing embryo. In healthy women, there is little that can be done to prevent miscarriage from happening.

Symptoms of pregnancy loss

At the start of a miscarriage, many women will have bleeding and cramping, however, some women have no symptoms at all, and the miscarriage will be diagnosed on an ultrasound exam.

Treatment options

Miscarriages can be treated in three ways.

One is to wait for the pregnancy tissue to pass on its own. While this has the benefit of not having any medical intervention, it can take up to four to eight weeks to occur, so many women prefer not to have the uncertainty of waiting that long.

The second option is to take a medication called misoprostol that causes the uterus to contract and expel the pregnancy tissue. This usually happens within 24 hours of taking the medication, but can take up to several days. The medication can be repeated if it does not work after the first dose. This is effective 70-90% of the time.  Management with medication has the advantage of being able to control the timing of miscarrying while still being able to be in the comfort of your own home, however, there is typically a several hour window of time that is very uncomfortable with heavy bleeding and cramping.

The third option is to have the pregnancy tissue removed surgically through a procedure called a dilation and curettage (D&C). This allows for the most control of timing and least amount of pain, however, does mean receiving anesthesia and undergoing a surgical procedure.

Follow-up

After a miscarriage, you will be seen in the office to confirm that all the pregnancy tissue has been passed and to discuss any questions you might have about the process. Your bleeding will typically taper down and eventually stop after one to two weeks. Your periods will typically resume four to six weeks later.

Planning for another pregnancy

Many women who are trying to get pregnant wonder when they can begin trying again after a miscarriage. While women used to be advised to wait a couple cycles before trying, newer data shows that there is no advantage to waiting and that there may be some advantage to attempting in the first three months after a miscarriage. The bottom line: when you feel physically and emotionally ready to try again, it is safe to do so