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UJIAN SKILL LAB
HOW TO GIVE ADVICE TO PREGNANT WOMEN IN ORDER THEY

ARE NOT INFECTED BY COVID-19
Diajukan untuk memenuhi Tugas Individu Mata kuliah Bahasa Inggris II.
Dosen Pengampu :
Erika, S.Kep, M.Kep., Sp.Mat
Disusun oleh:
DILLA AULIA
NIM. 18111224764
FAKULTAS KEPERAWATAN
UNIVERSITAS RIAU
PEKANBARU
2020
COVID-19 virus infection and pregnancy
Occupational health advice for employers and pregnant women during the COVID-19
pandemic.
1. Introduction
Everyone in the UK is advised to follow guidance from the Government to
lessen the spread of COVID-19. As of 23 March 2020, this has been updated to
guidance to stay at home, with the exception of a limited number of circumstances,
detailed here. However, for individuals in key professions, travelling to and
participating in work remains essential in this national emergency. For pregnant
women in these key professions, and in particular for pregnant healthcare
professionals, the following information may be helpful when discussing how best to
ensure health and safety in the workplace with their occupational health teams.
2. Available information about risks of contracting COVID-19 in pregnancy

COVID-19 poses a risk to all members of the population, particularly to
people with comorbidities. The groups who appear to be at the lowest risk of
developing severe disease are children and healthy adults. It is reassuring that there is
as yet no robust evidence that pregnant women are more likely to become infected
than other healthy adults.
Risk to pregnant women
It is known from other respiratory infections (e.g. influenza, SARS) that
pregnant woman who contract significant respiratory infections in the third trimester
(after 28 weeks) are more likely to become seriously unwell. This may also lead to
preterm birth of the baby, intended to enable the mother to recover through improving
the efficiency of her breathing or ventilation. Given these additional considerations
for pregnant women who become seriously unwell in the later stages of pregnancy,
the Government has taken the precautionary approach to include pregnant women in a
vulnerable group. This is so that pregnant women are aware of the current lack of
available evidence relating to this virus in pregnancy; and particularly, to encourage
awareness that pregnant women in later stages of pregnancy could potentially become
more seriously unwell.
Risk to the baby
Currently, there is no evidence to suggest that COVID-19 causes problems
with the baby’s development or causes miscarriage. With regard to vertical
transmission (transmission from mother to baby antenatally or intrapartum), emerging
evidence now suggests that vertical transmission is probable. There has been a report
of a single case in which this appears likely, but reassuringly the baby was discharged
from hospital and well. In all previously reported cases, infection was found at least
30 hours after birth. The proportion of pregnancies affected by vertical transmission
and the significance to the neonate is not yet known.
No previous coronavirus has been shown to cause fetal abnormalities; and,
while COVID-19 is new, the absence of reports of an increased incidence of fetal
abnormality at routine scans in Asia indicates this is likely to be the same for the
novel coronavirus. Although the evidence to date available offers no evidence of
harm, it is not possible to give absolute assurance to any pregnant woman that
contracting COVID-19 carries no risk to her baby and no risk to her over and above
that experienced by a non-pregnant healthy individual. The information above
combines the limited evidence from COVID-19 so far with evidence extrapolated
from other similar viral illnesses. We are actively weeking more evidence and will
update this guidance when this is available.
3. Recommendations for pregnant healthcare workers

In the UK, there already exist significant protections in law for pregnant
workers. These must be followed in relation to COVID-19. NHS Employers should
do everything possible to maintain the health of their pregnant employees. The central
aspect of this protection is based on risk assessment of each individual pregnant
worker’s working environment and the role they play. Acknowledging the evidence
above and following discussion with the Government and UK Chief Medical Officers,
the following recommendations should guide pregnant healthcare workers and
occupational health teams in conducting this risk assessment.
Protection of all pregnant healthcare workers

In light of the limited evidence, pregnant women of any gestation should be
offered the choice of whether to work in direct patient-facing roles during the
COVID-19 pandemic. This choice should be respected and supported by their
employers. Suitable alternative duties might include remote triage, telephone
consultations, governance or administrative roles. This is in line with the national
guidance that workers, including healthcare professionals, who are also identified by
the Government as vulnerable to COVID-19 should be able to participate in their own
risk assessment.
Choices for pregnant healthcare workers prior to 28 weeks’ gestation

Pregnant women who choose to work in patient facing roles after occupational
health risk assessment, prior to the third trimester of pregnancy, should be supported
to do so by minimising risk of transmission through established methods. It may not
be possible to completely avoid caring for all patients with COVID-19. As for all
healthcare workers, use of personal protective equipment (PPE) and risk assessments
according to current guidance will provide pregnant workers with protection from
infection.
The arrival of rapid COVID-19 testing will significantly assist in organising
care provision, and this guidance will be updated appropriately when such tests are
commonly available. Some working environments (e.g. operating theatres, respiratory
wards and intensive care/high dependency units) carry a higher risk of exposure to the
virus for all healthcare staff, including pregnant women, through the greater number
of aerosol-generating procedures (AGPs) performed.
These procedures are summarised in the PHE publication ‘Guidance on
Infection Prevention and Control’. When caring for suspected or confirmed COVID-
19 patients all healthcare workers in these settings are recommended to use
appropriate PPE. Where possible, pregnant women are advised to avoid working in
these areas with patients with suspected or confirmed COVID-19 infection.
Healthcare workers after 28 weeks’ gestation or with underlying health

conditions
For pregnant women from 28 weeks’ gestation, or with underlying health
conditions such as heart or lung disease at any gestation, a more precautionary
approach is advised. Women in this category should be recommended to stay at home.
For many healthcare workers, this may present opportunities to work flexibly from
home in a different capacity, for example by undertaking telephone or
videoconference consultations, or taking on administrative duties.
All NHS employers should consider how to maximise the potential for
homeworking given current relaxation of NHS Information Governance requirements,
wherever possible. Staff in this risk group who have chosen not to follow government
advice and attend the workplace must not be deployed in roles where they are
working with patients. Services may want to consider deploying these staff to support
other activities such as education or training needs (e.g. in IPC or simulation).
These measures will allow many pregnant healthcare workers to choose to continue to
make an active and valuable contribution to the huge challenge facing us, whether at
home or in the workplace, until the commencement of their maternity
References
1. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women:
population based cohort study. BMJ 2010;340:c1279. doi: 10.1136/bmj.c1279
2. Zhang J, Wang Y, Chen L, et al. Clinical analysis of pregnancy in second and third
trimesters complicated severe acute respiratory syndrome. Zhonghua Fu Chan Ke Za Zhi
2003;38:516-20.
3. Liu Y, Chen H, Tang K, et al. Clinical manifestations and outcome of SARS-CoV-2
infection during pregnancy. Journal of Infection 2020;Online doi:
https://doi.org/10.1016/j.jinf.2020.02.028
4. Dong L, Tian J, He S, et al. Possible Vertical Transmission of SARS-CoV-2 From an
Infected Mother to Her Newborn. JAMA 2020 doi: 10.1001/jama.2020.4621
5. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical
transmission potential of COVID- 19 infection in nine pregnant women: a retrospective
review of medical records. Lancet 2020 doi: https:// doi.org/10.1016/S0140-6736(20)30360-3
6. Chen Y, Peng H, Wang L, et al. Infants Born to Mothers With a New Coronavirus
(COVID-19). Frontiers in Pediatrics 2020;8(104) doi: 10.3389/fped.2020.00104
7. Li N, Han L, Peng M, et al. Maternal and neonatal outcomes of pregnant women with
COVID-19 pneumonia: a case-control study. . Pre-print doi: 10.1101/2020.03.10.20033605

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UJIAN SKILL LAB

HOW TO GIVE ADVICE TO PREGNANT WOMEN IN ORDER THEY

2. Available information about risks of contracting COVID-19 in pregnancy

3. Recommendations for pregnant healthcare workers

Protection of all pregnant healthcare workers

Choices for pregnant healthcare workers prior to 28 weeks’ gestation

Healthcare workers after 28 weeks’ gestation or with underlying health

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