key: cord-307329-gfwllo1r
authors: Bahtiyar, Mert Ozan; Baschat, Ahmet; Deprest, Jan; Emery, Stephen; Goodnight, William; Johnson, Anthony; McCullough, Laurence; Moldenhauer, Julie; Ryan, Greg; Tsao, KuoJen; Van Mieghem, Tim; Wagner, Amy; Zaretsky, Michael
title: Fetal Interventions in the Setting of COVID-19 Pandemic: Statement from the North American Fetal Therapy Network (NAFTNet)
date: 2020-04-26
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.04.025
sha: 
doc_id: 307329
cord_uid: gfwllo1r

nan

Key words: fetal therapy, COVID-19, SARS-CoV-2, prenatal diagnosis, fetal intervention 44 to balance the risks and benefits of care provision, as we adapt our established practice in the 46 setting of the COVID-19 (SARS-CoV-2 infection) pandemic 1, 2 . The risks include: the interventional risk to the fetus and mother, treatment-related COVID-19 exposure to the HCP, 48 the impact on maternal and fetal health of procedures done in the setting of maternal COVID-19 49 infection, and the risks of not intervening in a timely manner on fetal and/or neonatal outcome 1 . 50

In an effort to balance these risks and to continue providing evidence-based fetal interventions 52 that reduce fetal morbidity and mortality, the North American Fetal Therapy Network 53 (NAFTNet, https://www.naftnet.org) suggests the following approach to fetal interventions in the 54 setting of COVID-19.* Prenatal care should be adjusted by optimizing appointment intervals, 55 patient self-assessment, such as home blood pressure monitoring, and the use of virtual 56 immediate intervention, and if the mother is stable, the procedure should be performed 120 using appropriate personal protective equipment (PPE). 121 13. Practice guidelines for procedures during the COVID-19 pandemic are continually 122 evolving as information emerges. NAFTNet will closely monitor emerging evidence and 123 will update our guidelines accordingly (https://www.naftnet.org). 124 14. All interventional research protocols should be suspended during the pandemic. No 125 clinical benefit for the fetus or newborn is lost, because the experimental outcomes are 126 unknown. However, we encourage recruitment of pregnant women and neonates with 127 COVID-19 infection into registries which may clarify the risk of vertical transmission 128 (Table 1) . 129 15. Fetal therapy centers must carefully consider whether they can still offer certain, highly 130 resource intensive, fetal procedures, if their staffing becomes depleted, either due to 131 illness or deployment to other intensive care areas. In regions with multiple fetal therapy programs, this may be a time for collaboration, volume reduction, and/or referral of certain cases. 134 16. Patients traveling between states, provinces or countries should be counselled that, by 135 such travel, they may expose themselves to a higher risk of COVID-19 infection. They 136 may also become obliged to remain at their destined center for an unpredictable period of 137 time. After some procedures, patients may return earlier than usual to their referring 138

HCPs, for ongoing monitoring and care. Fetal therapy centers should remain engaged 139 with the referring HCP by phone or telemedicine. If travel restrictions are implemented, 140 patients who need to travel to a distant fetal therapy center may require supporting 141 documentation. Some centers may decline to accept patients who are either COVID-19 142 positive or who come from regions with a high infection prevalence. 143 144 NAFTNet's suggested approach to the fetus, in the setting of the COVID-19 pandemic, 145 emphasizes the need for a comprehensive multi-disciplinary approach to maternal-fetal care. We 146 must carefully weigh the risks and benefits of all fetal interventions -considering whether the 147 potential benefits may or may not be achieved with alternate or delayed therapeutic approaches. 148

The risks of exposure of HCPs to COVID-19 and the availability of local resources must be 149 considered in such decisions. During the COVID-19 pandemic, fetal interventions should not 150 simply be defined as "elective" procedures. 

SAR-CoV2 (COVID-19): Is fetal surgery in 178 times of national disasters reasonable?

MFM Guidance for COVID-19

Virtually Perfect? Telemedicine for Covid-19

SMFM. Joint Statement on Elective Surgeries

pdf 186 5. SOAP. Interim Considerations for Obstetric Anesthesia Care related to COVID19

Safety Committee Position Statement on use of personal protective 190 equipment and hazard mitigation in relation to SARS-CoV-2 for practitioners 191 undertaking obstetric and gynecological ultrasound