Pregnancy-after-loss requires specialist care during pandemic

There are no specific guidelines for caring for a pregnancy after loss during Covid-19

Bereaved mothers and their families experiencing a pregnancy after loss (PAL) should continue to be supported during the Covid-19 pandemic to limit unintended consequences, an international study with Irish involvement is reporting.

Writing in Women and Birth (WOMBI), the official journal of the Australian College of Midwives, Pollock et al noted at present there were no specific guidelines, nor evidence-based guidance, for PAL and Covid-19.

Meanwhile, they added, maternity care provisions have been challenged attempting to balance the needs and safety of pregnant women and their care providers during the pandemic.

“This means, women with PAL should continue to be managed as an at-risk group and in keeping with international consensus guidelines developed to guide practice in subsequent pregnancy,” they added.

“However, anecdotes from across the globe suggest that current provision of care during Covid-19, may not necessarily be meeting those additional care needs for a woman and baby experiencing a pregnancy after loss and these may in turn lead to unintended consequences or indirect costs of Covid,” they added.

For their study, the researchers analysed current practice in three high-income countries — Australia, Ireland, and the United States.

They found that evidence-based practices which generally recommend increased surveillance during PAL may not be adhered to during the pandemic.

“This potentially carries the risk of unintended consequences such as subsequent stillbirth,” they wrote.

“Conversely practices may be implemented that are not based on evidence and may lack specificity or the understanding for the unique position facing women experiencing PAL.”

Maternity guidelines enacted for use in the Covid-19 pandemic in the main superseded existing guidelines which were based on a weight of evidence, and developed over many years, they said.

“The short- and long-term implications of these changes to standard maternity care provision remain to be seen,” they concluded.

“Families experiencing stillbirth today are likely to go on to have another pregnancy and therefore, reduction of services and care around stillbirth occurring today may well also have an impact well into the future.”


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