Simulations of Deliveries of SARS-CoV-2 Positive Pregnant Women and Their Newborn Babies: Plan to Implement a Complex and Ever-Changing Protocol

Abstract

Management of severe acute respiratory Syndrome corona virus-2 (SARS-CoV-2) infected pregnant women at time of delivery presents a unique challenge. The variability in the timing and the method of delivery, ranging from normal vaginal delivery to an emergent cesarean section, adds complexity to the role of the health care providers in the medical care of the patient and in the interactions, they have with other providers. These variations are further influenced by the availability of isolation rooms in the facility and adequacy of personal protective equipment. The protocols already set in place can be further challenged when the facility reaches its capacity to manage the patients.

To fulfill the goal of providing adequate management to the SARS-CoV-2 infected pregnant women and their infants, avoid variation from suggested guidelines, and decrease risk of exposure of the health care workers, the health care provider team needs to review the variations regularly. While familiarity can be achieved by reviewing the guidelines, clinical case simulations provide a more hands-on approach.

Using case-based simulations and current guidance from the Center for Disease Control, American Academy of Pediatrics, and recent reviews, we discuss a management guideline developed at our institution to facilitate provision of care to SARS-CoV-2 infected pregnant women during delivery and to their infants, while protecting health care providers from exposure, and in keeping with the local facility logistics.

Key Points

• Simulation of delivery of SARS-CoV-2 positive pregnant women can minimize the risk of exposure to healthcare professionals.

• Four common scenarios of delivery as described can be adapted for the evolving guidelines for the management of SARS-CoV-2 positive pregnant women.

• Integrating simulations of management of SARS-CoV-2 positive pregnant women is feasible in daily clinical routine.

Keywords

SARS-CoV-2 - COVID-19 - pregnant - delivery - newborn - discharge

• References

• 1 Li R, Chen X, Wang Y. , et al. Risk factors of healthcare workers with corona virus disease 2019: A retrospective cohort study in a designated hospital of Wuhan in China. Clin Infect Dis 2020; 2020 DOI: 10.1093/cid/ciaa287Epub.
• 2 Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020; 105 (01) 100-101
• 3 Considerations for Inpatient Obstetric Healthcare Settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html. Accessed May 24, 2020
• 4 Puopolo KM, Hudak ML, Kimberlin DW, Cummings J. Initial guidance: management of infants born to mothers with COVID-19. Available at: https://downloads.aap.org/AAP/PDF/COVID-19%2019%20Initial%20Newborn%20Guidance.pdf . Accessed May 24, 2020
• 5 Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings (Interim Guidance). Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html . Accessed May 24, 2020
• 6 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
• 7 Chandrasekharan P, Vento M, Trevisanuto D. , et al. Neonatal resuscitation and post resuscitation care of infants born to others with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020; DOI: 10.1055/s-0040-1709688.
• 8 For donning and doffing of PPE. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html . Accessed May 24, 2020
• 9 Riley W, Davis S, Miller K, Hansen H, Sainfort F, Sweet R. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf 2011; 37 (08) 357-364
• 10 Palatnik A, McIntosh JJ. Protecting labor and delivery personnel from COVID-19 during the second stage of labor. Am J Perinatol 2020; DOI: 10.1055/s-0040-1709689.