A retrospective evaluation of a multidisciplinary management strategy implemented to optimize outpatient care, hospitalization rates and clinical outcomes in a single-centre cohort of COVID-19-positive pregnant women in Australia during the Omicron BA.1 surge

Abstract

Abstract Background During the Omicron BA.1 surge between 12 January and 18 February 2022, 189 COVID-19-positive pregnant women were managed by the Peninsula Health Positive Pathways program, in the Mornington Peninsula, Victoria, Australia. A multidisciplinary specialist team was rapidly assembled to work in conjunction with the Pathways COVID-19 physicians and monitoring team, to optimize patient care. Objective The aim is to describe the processes utilized to care for the pregnancy cohort from the time of enrolment to the COVID Monitor until recovery including outpatient monitoring, treatment strategies, hospital review criteria, and clinical outcomes including rate of hospitalization, oxygen requirements, and maternal and foetal outcomes during the study period. Method Outpatients were monitored daily by the Pathways program, while COVID-19 physicians and obstetricians conducted early telehealth review of patients after diagnosis. Members of the multidisciplinary team met on a virtual platform twice daily, and institution-specific treatment guidelines and hospital review criteria were established. Enoxaparin prophylaxis was delivered to the homes of selected patients, and inhaled budesonide was utilized for patients who did not require oxygen, who were immunocompromised, and who had significant respiratory symptoms or risk factors for deterioration. Sotrovimab was offered to women as per the existing Australian National COVID-19 Clinical Evidence Taskforce eligibility criteria. A service evaluation was undertaken adopting a retrospective cohort approach. Results There was minimal maternal morbidity and no mortality with 24/189 (12.7%) women requiring hospitalization, 18/189 (9.5%) requiring same-day emergency department presentations only, and 4/189 (2.1%) requiring oxygen, with no requirement for non-invasive ventilation or intensive care unit admission. Sixteen patients delivered live newborns during the study period, and there were two pregnancy losses at 7 and 19 weeks gestation, respectively, in patients with prior pregnancy complications. Conclusion A multidisciplinary approach involving virtual communication twice daily between treating specialist physicians may be a broadly applicable model to optimize care of pregnant women with COVID-19.