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

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.

Pregnancy Loss and Miscarriage

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

Upcoming visit?

As we all have experienced, the current COVID19 pandemic has changed the way we do even life’s simplest things.  Going to the grocery store, although it’s never been one of my favorite things, is now like finding my way through a maze of one-way aisles.

Like most places, things are a little different at Bedford Commons OB-GYN right now.  We are still the same awesome team and we really are excited to see you but there are a few things that you should know before you come for your visit:

  1. Visitors – It’s awesome to meet your partner, parent, and children but right now, we need to limit the number of people in our office to keep our environment safe for all of our patients and team.  Because of this, unless you are under the age of 18, or require assistance, or are coming in for an obstetric ultrasound, no visitors will be permitted to accompany you to your visit.  We know this can be difficult, especially with childcare challenges.  However, we are committed to keeping everyone healthy which is why we cannot make any exceptions to this rule.  We are happy to FaceTime or do a phone call during your visit so someone else can be a part of your care.
  2. Pre-visit check-in – You will receive a text message and email 1 day before you appointment from Phreesia asking you to “Check-in”.  This is not actually checking you in but is our way of having you verify all of your information is correct and complete any paperwork we would have had you do at your visit.  This process takes between 1-4 minutes.  Completing it ahead of your appointment prevents you from having to fill out actual paperwork when you come in.
  3. Let us know you’re here! – For appointments in our Bedford location ONLY, let us know when you arrive by texting us at 603-668-4646.  We will ask you a few questions about signs and symptoms of COVID19 and recent travel.  As long as you completed the pre-visit paperwork from Phreesia, you’ll wait in your car until a room is ready.  For our Derry and Windham locations, because we can get you quickly in a room, come on in and check in and we will bring you right back to an exam room.
  4. Recent travel?  If you have recently traveled outside of New England, we may ask you to reschedule your visit.  Traveling to any areas with a >5% positivity rate increases the possibility that you may be exposed to COVID19.  Please call us if you have traveled in the past 14 days and we will let you know if we need to reschedule your appointment.

Questions?  This is all a little confusing so if you have any questions, just give us a call.  We would love to help!