Clinical Practice Resources

The purpose of this memo is to share information with perinatal care providers about some key changes to usual screening processes that have evolved out of the response to COVID-19. In addition, RCP is collecting data related to COVID-19 infections in pregnancy and in newborns, and are providing guidance about locations for documenting this information so that it can be coded by our health information colleagues.

Information in this memo has been developed through input with consultants of IWK and NSHA laboratory medicine, obstetrics, and maternal fetal medicine.

The purpose of these bulletins is to share current information and Nova Scotia guidance about care for pregnant and childbearing persons and newborns during the COVID-19 pandemic. Our NS guidelines may differ from those of other countries and possibly from other Canadian provinces. Please consult with IWK and/or NSHA program leaders before adopting any guidance from outside of NS. The format of these documents is adapted with permission from bulletins produced by Vancouver Coastal Health Authority. Our thanks for their willingness to share with Nova Scotia.

Knowledge, understanding and terminology about COVID-19 is changing rapidly. Information in these documents will be modified in response to new data and evidence. NEW content added will be indicated as such. Please check http://rcp.nshealth.ca to ensure you are referring to the latest Maternal Newborn Care Bulletin.

(Downloadable version below)

Pregnant women require regular antenatal visits throughout pregnancy. However, if there is a need to reduce the number of visits for office/clinic crowding reasons, or because a woman herself wishes to reduce her exposure to other people, the timing and frequency of prenatal visits can be adjusted.

Prior to attending a scheduled prenatal office or clinic visit, women should answer the screening questions and call 811 if appropriate. Some women will be directed to a screening centre before attending their prenatal appointment.

For low-risk women and those for whom there are no identified maternal obstetrical or fetal concerns, it is acceptable to adjust the prenatal visit schedule to align with the WHO Antenatal Care Model (2016). The visit schedule below includes nine prenatal visits and is a slight modification of the WHO schedule.

  • First prenatal visit up to 12 weeks
  • 20 weeks
  • 26 weeks
  • 30 weeks
  • 34 weeks
  • 36 weeks
  • 38 weeks
  • 39 weeks
  • 40 weeks

Please note:

  • A responsible care provider must assess each woman to determine whether she is a candidate for an adjusted prenatal visit schedule.
  • Prenatal blood work and prenatal ultrasounds are important aspects of prenatal care. These investigations should be offered as usual, and should be scheduled in conjunction with prenatal visits as much as possible.
  • The SOGC has recommended on-going fetal surveillance in confirmed cases of COVID-19. Operational details to enact this recommendation have not yet been determined.

For women who have known or suspected maternal obstetrical and/or fetal health concerns, the schedule for prenatal visits should be determined based on medical needs.

For questions about precautions for women who are known to be COVID-19 positive, or are being investigated for COVID-19, and for questions about accompanying support people, please refer to guidance from the Nova Scotia Department of Health & Wellness, the NSHA and the IWK Health Centre.

As of January 20, 2020, the Office of the Chief Medical Officer of Health for Nova Scotia has declared a provincial syphilis outbreak. Across Canada syphilis outbreaks have been declared in most provinces/territories, due to increasing rates of infection. Changes to recommendations for pregnant women and newborns are outlined in the documents below:

The Canadian Paediatric Society (CPS) has recommended moving from universal newborn ocular prophylaxis, to universal prenatal screening for Neisseriae gonorrhoeae (GC) and Chlamydia trachomatis (CT) and treatment of those with positive results in order to eradicate infection and prevent intrapartum transmission to the newborn.

As universal ocular prophylaxis is eliminated from routine newborn care, functions of the health system must be optimized and synchronized to prevent ON. RCP has partnered with clinical experts and stakeholders from across NS to produce these resources, which are designed to offer guidance for the prevention of ON:

Key messages for health care providers

  • Black-legged or deer ticks (BLT) are found throughout Nova Scotia. Preventing a BLT bite is the most effective way to prevent Lyme disease. Risk reduction strategies include using DEET-containing insect repellant (safe to use in pregnancy) and careful ‘tick checks’ after being in grassy or wooded areas, including a park or yard. Immediate and correct removal of an attached BLT is key to prevention. For advice about tick removal see: https://novascotia.ca/dhw/CDPC/lyme.asp.
  • Prophylaxis may be considered. A single 200 mg dose of doxycycline, which is not contraindicated for pregnant women, may be offered if all of the following criteria are met.
    • BLT attached for > 24 hours, AND
    • antibiotic prophylaxis is given < 72 hours from tick removal, AND
    • the bite occurred in an area considered at higher or moderate risk for Lyme disease, which is most of NS. For risk level by NS County see map at this link: https://novascotia.ca/dhw/CDPC/lyme.asp.
  • The risk of Lyme disease after a bite from an infected BLT is low (1.2%-3.2%). However, if a bite occurs advise observation for signs and symptoms for 30 days, even if there has been prophylaxis.
  • Think about Lyme disease in your differential for a patient presenting with new onset febrile illness, especially when associated with a localized skin lesion. Early infection is a clinical diagnosis.  The sensitivity of two-tiered serologic testing, the recommended testing standard in Canada and the US, is < 50% in early, localized Lyme disease. The test performs well in early disseminated and in late Lyme disease. For information about testing see: https://novascotia.ca/dhw/cdpc/documents/statement_for_managing_LD.pdf.
  • Treatment for pregnant women with Lyme disease is similar to treatment for the general adult population, with the exception that treatment doses of doxycycline are contraindicated in pregnancy. With 10-28 days of oral antibiotic treatment, 95% of cases of Lyme disease are resolved. For treatment recommendations see: https://novascotia.ca/dhw/cdpc/documents/statement_for_managing_LD.pdf
  • There is not enough evidence to confirm that Lyme disease during pregnancy has adverse effects for the fetus. In addition, no adverse effects for the fetus have been observed when the pregnant woman receives appropriate antibiotic treatment for her Lyme disease.

For more information about Lyme disease, refer to the following resources:

From the Government of Canada and the Public Health Agency of Canada

From the Nova Scotia Department of Health & Wellness

TO: NS Perinatal Care Providers
FROM: Reproductive Care Program
DATE: December 1, 2017
RE: Zika Virus in Pregnancy


Recommendations for screening pregnant women with potential exposure to Zika virus are evolving. The current screening recommendations are summarized below. Included with this memo are copies of the Nova Scotia ZIKA TESTING ALGORITHM – INTERIM GUIDANCE and the Nova Scotia ZIKA CLINICAL INFORMATION DATA SHEET – INTERIM GUIDANCE.

  • All pregnant women with a potential exposure to Zika virus require assessment, regardless of whether they develop symptoms. Potential exposure is defined as personal travel to a Zika area any time after the date of the woman’s LMP or unprotected sexual contact with a male who has traveled to a Zika area in the last 6 months. For the most recent Zika Virus Travel update refer to the PHAC website at http://travel.gc.ca/travelling/health-safety/travel-health-notices
  • Symptomatic pregnant women should be referred to the Fetal Assessment & Treatment Centre (FATC) at the IWK. These women will need blood and urine specimens collected and sent to the Department of Pathology and Laboratory Medicine, Central Zone as described in the ZIKA TESTING ALGORITHM. The ZIKA CLINICAL INFORMATION DATA SHEET must be completed and sent with the specimens.
  • Asymptomatic pregnant women who have traveled to a Zika area since their last LMP, or have had unprotected sexual contact with a male who has traveled to a Zika area in the last 6 months, should be referred to the FATC for triage. All should be offered Zika virus serology as described in the ZIKA TESTING ALGORITHM and the ZIKA CLINICAL INFORMATION DATA SHEET must be completed and sent with the specimens.  Consultants in the FATC will determine the best timing and location for ultrasound surveillance based on the woman’s individual circumstances, such as timing of exposure and gestational age.
  • The FATC referral form should include the woman’s LMP, the circumstances of her exposure in the context of gestational age (include travel history or history of unprotected sexual contact with a male who may have been exposed to Zika virus), the presence or absence of symptoms consistent with Zika virus in the woman or her partner, the timing of the appearance of symptoms (if relevant), whether or not a blood sample has been sent for Zika serology and, if so, the date the sample was collected.
  • The timing of Zika serology is important.  Zika serology for an asymptomatic pregnant woman should be done NO SOONER than three weeks following the last exposure. At this time Zika serology for male partners of pregnant women is not being offered in Canada. Because all testing is done at one lab in Winnipeg the priority is pregnant women. In addition, the interpretation of a negative test in this context is difficult.
  • The FATC referral form can be found at: http://www.iwk.nshealth.ca/sites/default/files/IWK_MAFE.pdf or on the IWK website under the tab, ‘For Health Professionals’ and the option ‘Referral Forms for External Physicians’.  A new form must be printed for each referral (due to the barcode) and the form must be faxed to FATC at 902-470-7987.
  • Remind each pregnant woman that her male partner should use condoms for the duration of the pregnancy.
  • Remind each woman who could become pregnant, that her male partner should use condoms for 6 months from the time of travel to a Zika area. If a woman becomes pregnant within two months of personal travel to a Zika area, or within 6 months of her male partner traveling to a Zika area, the need for testing must be assessed on an individual basis through the FATC.
  • More detailed information, including links to all current national and international recommendations for pregnant women with regard to Zika virus exposure, is available from the Society of Obstetricians and Gynecologists of Canada at:  https://sogc.org/news-items/index.html?id=135

Nova Scotia recommendations related to pregnancy and Zika virus exposure will be updated on the RCP website as new information becomes available.  Please check back regularly at http://rcp.nshealth.ca

The Nova Scotia guidelines for antenatal laboratory screening and testing were revised and re-released in June 2015. The guidelines are available in a convenient printable card format. The companion document to the new Nova Scotia Prenatal Record provides detailed information on applying these guidelines.