Table 1 Considerations at in-person antenatal visits for low-risk pregnancies

Initial visit

Determine eligibility for low-risk modified schedule

Aneuploidy screening

• Continue to offer

• Preferred option - first trimester screen (FTS) which includes ultrasound assessment of nuchal translucency, twin chorionicity, fetal anomalies [62] and pregnancy dating.

• [For COVID-19 positive or suspected persons, defer for 2 weeks if still in the appropriate window, or to screen with non-invasive prenatal testing (NIPT) or second trimester maternal serum screening] [51].

Anatomical ultrasound

• Continue to offer; prioritize over other obstetrical ultrasounds [51].

• Discourage early anatomical scans (< 18 weeks) and encourage later scans (closer to 22 weeks) to reduce risk of suboptimal views and need for repeat scans.

Screening for gestational diabetes mellitus (GDM)

• Continue to offer

• Avoid protocols involving longer wait times and multiple contacts between care providers and patients for blood draws.

• Consider alternate screening strategies such as measuring glycosylated hemoglobin (HbA1c) and random plasma glucose (RPG) through a single blood draw at the 28-week visit, and diagnosing GDM if HbA1c ≥5.7% or RPG ≥11.1 mmol/L [63].

Third trimester visits

• Consider modified antenatal schedule (Fig. 2).

• Encourage self-monitoring of blood pressure, blood glucose, uterine height and fetal movements, if possible [42, 47, 48, 50, 52].

Ultrasound scans for fetal growth and wellbeing

• Adhere to ISUOG consensus statement [51].

• Consider discussing ultrasound findings via telephone [29]

• (Experimental) – consider using 28-week placental growth factor testing [64] to determine those in whom routine third-trimester ultrasound scans can be avoided.

• [No strong evidence to suggest 2-to-4-weekly ultrasound assessments [18, 34, 39, 55] for those with COVID-19, since unlike with Severe Acute Respiratory Syndrome [53], there is no conclusive data suggesting an association between COVID-19 infection fetal growth restriction].

Group B Streptococcal (GBS) Screen

• Continue to offer, but consider self-administration by pregnant person, timed with a scheduled in-person visit between 35 and 37 weeks (Fig. 2).

• [In those with confirmed or suspected COVID-19, testing could either be delayed by up to 14 days or intrapartum antibiotic prophylaxis could be administered using a risk-factor-based approach.] [34, 37]