What is the recommended management for a pregnant woman in her second trimester with mild COVID-19 (Coronavirus Disease 2019) symptoms, suitable for outpatient care?

Management of Pregnant Women with Mild COVID-19 in the Second Trimester

For pregnant women in the second trimester with mild COVID-19 symptoms, outpatient management with intensive telehealth monitoring is recommended as the primary approach to care, minimizing in-person visits while ensuring appropriate surveillance for symptom progression. 1

Outpatient Triage Protocol

Initial Assessment

• All pregnant women should wear masks when seeking medical care 2
• Temperature screening should be conducted for all patients and accompanying persons 2
• Screening questions should assess:
  • Presence of COVID-19 symptoms
  • Exposure history
  • Travel history to high-risk areas

Telehealth Management

• Implement protocol-driven telehealth follow-up for systematic monitoring 1
• Schedule regular virtual prenatal care visits to:
  • Assess symptom progression
  • Provide routine prenatal care
  • Determine need for in-person evaluation 1

Warning Signs Requiring Urgent Evaluation

Patients should be instructed to seek immediate medical attention for:

• Fever (particularly concerning symptom) 1
• Worsening cough 1
• Progressive shortness of breath 1
• Chest pain 1
• Severe nausea and vomiting 1
• Oxygen saturation below 95% (if home monitoring available) 3

Home Care Instructions

Symptom Management

• Rest and adequate hydration
• Acetaminophen for fever control (preferred over NSAIDs in pregnancy)
• Position changes to optimize oxygenation (left lateral positioning when resting)

Isolation Measures

• Self-quarantine for 14 days from symptom onset 3
• Separate sleeping arrangements if possible
• Mask wearing when in contact with household members
• Frequent hand hygiene
• Regular disinfection of high-touch surfaces

Criteria for Escalation to Hospital Care

Indications for Inpatient Management

• Moderate to severe symptoms 3
• Oxygen saturation below 92-95% 3
• Inability to maintain oral hydration
• Obstetric concerns requiring in-person evaluation

Follow-up Protocol

• Continue telehealth monitoring until symptom resolution
• Plan for viral testing clearance (median time to viral clearance is approximately 26 days) 1
• Resume regular prenatal care schedule after recovery

Important Considerations

• Disease progression and time to viral clearance do not appear to vary significantly by trimester 1
• 95% of patients requiring acute care are identified through telehealth evaluation, demonstrating the effectiveness of this approach 1
• Only about 13% of symptomatic pregnant women with COVID-19 require hospitalization 1

Pitfalls to Avoid

• Do not dismiss mild symptoms, as they may rapidly progress
• Avoid unnecessary in-person visits that increase exposure risk
• Do not neglect routine prenatal care while managing COVID-19
• Remember that pregnant women may deteriorate more rapidly than non-pregnant patients with similar initial presentations

The evidence demonstrates that with proper protocol-driven outpatient monitoring, the majority of pregnant women with mild COVID-19 symptoms can be safely managed without hospitalization 1, while maintaining appropriate vigilance for the small percentage who may require escalation of care.