Intrapartum care of women with COVID-19: A practical approach

Abstract

Obstetricians have steadily fought to improve outcomes for women over the past 3 decades, with the application of evidence-based medicine. The current COVID-19 pandemic has overwhelmed this standardized approach with a deluge of information, at times contradictory, leading to confusion in the labor ward regarding best practice. As community person-to-person transmission of the virus escalates, we will increasingly have to manage labor for COVID-19 positive patients. In this context, we have developed a comprehensive but concise information bulletin (Fig. 1), to allow all caregivers ease of access to the most up to date information. This is based on recommendations issued by the International Society of Ultrasound in Obstetrics and Gynecology [[1]Poon L.C. Yang H. Lee J.C.S. Copel J.A. Leung T.Y. Zhang Y. et al.ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals.Ultrasound Obstet Gynecol. 2020; (published online March 11)Crossref Scopus (133) Google Scholar], Royal College of Obstetricians and Gynaecologists [[2]Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection and pregnancy. https://www.rcog.org.uk/coronavirus-pregnancy (accessed March 30, 2020).Google Scholar], Collège National des Gynécologues et Obstétriciens Français [[3]Peyronnet V. Sibiude J. Deruelle P. Huissoud C. Lescure X. Lucet J.C. et al.Infection with SARS-CoV-2 in pregnancy. Information and proposed care. CNGOF.Gynecol Obstet Fertil Senol. 2020; (published online March 18)Google Scholar], and Society for Obstetric Anesthesia and Perinatology [[4]Society for Obstetric Anesthesia and Perinatology. Interim Considerations for Obstetric Anesthesia Care related to COVID-19. https://soap.org/education/provider-education/expert-summaries/interim-considerations-for-obstetric-anesthesia-care-related-to-covid19 (accessed March 30, 2020).Google Scholar]. Most of the recommendations highlighted in our bulletin are similar between the international bodies: multidisciplinary approach; mode of delivery as usually indicated; close monitoring of maternal vital signs; continuous fetal heart monitoring; conservative fluid therapy; oxygen therapy as needed; early neuraxial anesthesia; elective instrumental delivery according to maternal condition; and stabilization of the critically ill patient by specialists followed by cesarean section and appropriate protective measures. However some discrepancies can be found between recommendations regarding the presence of birth partner, delayed umbilical cord clamping, separation of mother and baby, and use of nitrous oxide analgesia systems. We have to keep in mind that our current knowledge on management of COVID-19 during pregnancy is based on small cohort studies, experience of similar viral pulmonary infections and expert consensus, which generate divergent recommendations. Thus, guidelines will no doubt be adapted as we gather clinical data and experience. Despite these anticipated developments, health care facilities should procure clear management protocols for care providers. Furthermore, it is also important for team members to undertake training in proper utilization of personal protective equipment and scenario simulation, such as emergency cesarean section, in order to ensure efficiency in patient care as well as protective measures. We declare no competing interest.