Coronavirus Disease-19 (Covid-19) in Pregnancy
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults, Updated for the 2023 Edition
U07.1/U07.2
*Notifiable medical condition.
ANTENATAL CARE
- Antenatal care is an essential service and should not be scaled down during lockdown periods.
- Screening and testing criteria for SARS-CoV-2 infection during pregnancy is the same as for the general population.
- Vaccination against Covid-19 and influenza is safe at all gestations of pregnancy and during COVID-19 pandemic it is important that pregnant women take up the COVID-19 and influenza vaccine to reduce their risk of contracting either. See: Other vaccines.
- The clinical course and outcome of COVID-19 is not different in pregnancy and most pregnant women who are infected with SARS-CoV-2 will experience only mild or moderate symptoms.
- Up to 75% of infected women in pregnancy may be asymptomatic, and appropriate PPE must be used for all deliveries, regardless of the status of the mother. All pregnant women attending hospital, including women in labour, should wear masks.
- Maternal COVID-19 is associated with an approximately three times greater risk of preterm birth and women should be counselled on warning signs of spontaneous preterm labour.
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- Risk factors for more severe disease or admission to hospital with COVID-19 include:
- Obesity (pre-pregnancy BMI >30 kg/m2).
- Co-morbidity, such as pre-existing diabetes (see: Diabetes mellitus in pregnancy) and chronic hypertension (see: Chronic hypertension).
- Age >35 years
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- SARS-CoV-2 infection is not associated with an increase in the incidence of congenital abnormalities.
THROMBOPROPHYLAXIS
All pregnant women admitted with confirmed or suspected COVID-19 should be offered prophylactic LMWH or unfractionated heparin for 10 days, unless birth is expected within 12 hours. See: Venous thrombo-embolism.
DELIVERY
- COVID-19 infection is not an indication for delivery, unless delivery is required as part of maternal resuscitation to improve maternal oxygenation.
- When a woman with COVID-19 presents with spontaneous preterm labour, suppression of labour (to delay delivery in order to administer antenatal corticosteroids) should not be done.
- All women with confirmed or suspected SARS-CoV-2 infection must preferably deliver in a dedicated COVID-19 hospital or ward.
MEDICINE TREATMENT
Observe oxygen saturation measurement hourly.
- Oxygen, if saturation is <94%.
Symptomatic relief of headache:
- Paracetamol, oral, 500 mg to 1 g, 4 to 6 hourly as required (to a maximum of 4 g in 24 hours).
- Maximum dose: 15 mg/kg/dose.
Note:
Avoid morphine analgesia if patient is respiratory compromised.
In pregnant patients who require supplemental oxygen:
- Corticosteroids crosses the placenta and may have long-term deleterious effects on the child.
If corticosteroids are also needed to accelerate foetal lung maturity: See: Preterm labour (PTL) and preterm prelabour rupture of membranes (PPROM).
If corticosteroids are not needed for foetal lung maturity:
- Corticosteroids, e.g.:
- Dexamethasone, IV, 6 mg daily for up to 10 days, or until discharge.
If there is a concern over in-utero steroid exposure, use alternative therapy (with less placental transfer):
- Prednisone, oral 40 mg daily, for up to 10 days, or until discharge.
OR - Hydrocortisone, IV, 80 mg 12 hourly for up to 10 days, or until discharge.
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Anaesthetic:
- Spinal anaesthesia is the anaesthetic of choice in the absence of contra-indications. See: Anaesthesia, Spinal (Intrathecal). The patient should wear a surgical facemask for the duration of the perioperative period.
POSTPARTUM
- Infection with SARS-CoV-2 is not a contra-indication to breast feeding.
- There is no contra-indication to the use of post-partum contraception (See Primary Healthcare: National Dept. of Health, Standard Treatment Guidelines Family Planning)
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026
Chapter 6 Obstetrics_6.5 Coronavirus Disease-19 (COVID-19) in Pregnancy