Step 1. Determine pregnancy status

The first step in providing maternal and newborn services during the COVID-19 pandemic is to determine pregnancy status. Once a woman discovers she is pregnant, she will either contact a Community Health Worker (CHW) to provide an antenatal care (ANC) assessment or visit a health center facility directly to confirm her pregnancy and receive ANC. Alternatively, pregnancies in the community may be discovered through routine pregnancy surveillance. In this instance, facilities will provide pregnancy and COVID-19 assessments using the surveillance process and tools described in Slide 2. Note that both the woman and CHW should be wearing face masks when in the same room. In the health facility, the waiting area should be a well-ventilated room (or an outside space) in which other outpatients/families are socially distancing and wearing masks.

At the first point of contact between a pregnant woman and a CHW/healthcare provider, the woman will be enrolled in the pregnancy register cohort and local area monitoring system which helps CHWs follow the woman throughout her pregnancy and determine her estimated delivery date. During pregnancy assessment, women should be evaluated for potential SARS-CoV-2 infection, the virus that causes COVID-19, by considering the presence of suggestive symptoms, contact with family members or other persons with diagnosed or presumed COVID-19, and the extent of COVID-19 spread within the community. CHWs should be aware that pregnant women with COVID-19 may have mild symptoms (such as fatigue and headache). Additionally, other serious health conditions (e.g., malaria, dengue, preeclampsia, gestational diabetes) have similar symptoms to COVID-19, and thus CHWs must be vigilant in assessing these possibilities. If a CHW suspects a pregnant woman has COVID-19 either due to symptoms of COVID-19, potential recent contact with family members or other persons with diagnosed or presumed COVID-19, or both, the pregnant woman should be referred for testing.

Points of contact between women and health providers at which COVID-19 may be detected and steps for referral include:

Women without COVID-19 symptoms:

If a woman does not have symptoms of COVID-19, then she should be referred to a health facility for a routine ANC visit.

Women with COVID-19 symptoms:

If a CHW discovers during initial assessment that a woman has symptoms suggestive of COVID-19 or recent close contact with someone with COVID-19, the CHW should refer the woman to a COVID-19 testing and treatment center immediately. Women should receive information on home isolation while waiting for the test results, and if test is positive, she should follow the United Nations Population Fund (UNFPA) quarantine guidelinespdf iconexternal icon. All women who test positive for COVID-19 should have contact tracing follow-up in the community.
If a woman exhibits symptoms of COVID-19 during a health facility assessment, she should be referred to a treatment center for a COVID-19 test as promptly as possible, after conducting assessments for other conditions which can present with similar symptoms.
If at any point during the initial ANC or pregnancy status assessment a woman exhibits severe symptoms consistent with COVID-19 (specifically, trouble breathing; persistent pain or pressure in the chest; new confusion; inability to wake or stay awake; bluish lips or face; fever > 38.6 °C; or severe cough, nausea, vomiting, or diarrhea), she should immediately be referred to the COVID-19 treatment center for treatment.

Note: Please see further detail on CDC-recommended triage process for COVID-19 patients here.

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