Management of Covid 19

in pregnancy
~Dr Preetiba Rani Vijay~
Obstetrics & Gynaecology Specialist
Hospital Sungai Buloh
 Outline
• Establishing a dedicated O&G Unit
• Antenatal care
• Intrapartum management
• Postpartum care
 Establishing a dedicated O&G Unit
• Screening ALL patients
• Form a core team
- Comprise of at least 2 O&G specialist/consultant, 3-4 Medical Officers and 2
midwives
- Optimally trained in management of COVID-19 patients apart from handling
the personal protective equipment (PPE)
- Training on “donning and doffing” of PPE is compulsory and they should also
manage specimen collections and exercise universal precautions at all time
• Universal precaution
- The number of staffs managing should be kept to a minimum number
- Patient should wear a 3 ply face mask at all times
- Treat the body fluids, tissues (placenta) and apparels as potentially
biohazards
- The labour suite and the operating theatre should be cleaned based on
universal recommendations following a biohazard exposure
• Transfer & documentation
- 3ply mask at all times
- Health care workers (HCW) in full PPE
- Documentation of all HCW involved

• Designated labour suite

- Ideally be nearest to the point of entry (PAC or Isolation ward)
- Preferably have negative pressure ventilation
- Disposable equipments are preferred
- HCW in full PPE
- Cleansing of the labour room should adhere to biohazard decontamination protocols
• Designated Operation Theatre (OT)
- Fully equipped with negative pressure ventilation recommended (more
essential for patients requiring general anaesthesia)
- Design a defined pathway from entry point (PAC or Isolation ward) to OT
• Husband and baby friendly policy need to be put on hold
 Antenatal management
• In patient management for ALL covid positive pregnant mothers
• Risk stratification
- Symptoms
- Obstetric issues
- Medical co-morbids
• Venous Thromboembolism Scoring (VTE scoring)
- Start prophylactic anticoagulation therapy according to VTE score
- Adequate hydration and mobilization
• Fetal monitoring
- Daptone
- CTG upon admission (>32 weeks) or when indicated
- Fetal kick chart
• Antenatal steroids for fetal lung maturity
- Maternal condition and the need for iatrogenic premature delivery
- Close collaboration with paediatric team
 Intrapartum management
• Mode of delivery
- No evidence of vertical transmission
- Concerns of prolonged exposure of staff during the entire intrapartum period
- Risk of aerosol exposure is significant, especially in the second stage of
labour when the patient strains or pushes
- Limited negative pressure ventilation room
- If not in imminent labour → Caesarean section
- Imminent labour → Vaginal delivery in a negative pressure ventilation room
with full PPE
• Fetal monitoring
- Follow standard obstetric care

• Anaesthesia
- Regional recommended
- Recommended number of staff to manage a patient during caesarean section is 7:
✓ One Obstetrician
✓One Assistant
✓One Anaesthetist
✓ One GA Nurse
✓One Scrub Nurse
✓One Circulating Nurse
✓One Floating Nurse
• Routine neonatal examination and care can be performed outside the
operating theatre to minimize exposure unless the neonate warrants urgent
resuscitation
• Additional staffs maybe needed
 Postpartum care
• Breastfeeding not recommended
• Baby in NICU
• Routine postpartum care
• Reassess VTE risk and start anticoagulant accordingly
Thank you