**7. Ante-natal care during COVID-19 pandemic**

Providing adequate antenatal care during the COVID-19 pandemic is a priority and a minimum number of antenatal visits should be ensured. Federation International of Gynaecology and Obstetrics (FIGO) suggests a minimum of six in-person antenatal visits i.e. at 12 weeks, 20 weeks, 28 weeks, 32 weeks, 36 weeks and at 37–41 weeks. Telemedicine can be used for any additional advice and facilities should be made available for tele-consultation.

Appointments should be taken before consultation and screening for any symptoms for COVID-19 should either be done telephonically or before entering the antenatal area [25]. Screening should include symptoms suggestive of COVID-19 illness, any history of recent travel, history of exposure to infected person and any history of immune-suppression [25].

FIGO recommends that any pregnant women testing positive on screening should have a minimum waiting period, should be tested for severity of symptoms, and evaluated as per local guidelines [25]. Screen-positive women should be isolated and not allowed near other pregnant women.

Screen-positive woman who contacts telephonically should be advised to defer the visit for 14 days unless there is an urgent need.

During antenatal visits, pregnant woman should be counselled about the general measures to prevent spread of infection like social distancing, use of face masks and respiratory hygiene. They should be educated about the symptoms of SARS-CoV2 infection and that even if they become infected, they are likely to have mild disease in most cases. They should be told that if they develop severe symptoms or recovery is delayed, they should seek care [25].

Pregnant women should be allowed only one accompanying person and he/she should also be screened at entrance to hospital.

They should also be counselled about the possible modifications in her antenatal plan in view of the ongoing pandemic. She should be told about dedicated COVID facilities in her neighbourhood and facilities where SARS-Cov2 positive women can deliver.

She should be advised to keep taking her routine health supplements e.g. folic acid during pregnancy.

There should a mechanism in place to track antenatal women who miss scheduled visits and they should be contacted telephonically.

Clinicians should be aware of the increased risk of psychological problems and domestic abuse during the pandemic and appropriate steps should be taken to address these issues including looking for signs, counselling and referral if needed. Particular concern has been raised about the increased need of psychological counselling and support services to the antenatal women during this time of pandemic when face to face consultation is not possible [25].
