Management Guidelines for Obstetric Patients and Neonates Born to Mothers With Suspected or Probable Severe Acute Respiratory Syndrome (SARS)

Abstract

The Society of Obstetricians and Gynaecologists of Canada. Recommendations 1. All hospitals should have infection control systems in place to ensure that alerts regarding changes in exposure risk factors for SARS or other potentially serious communicable diseases are conveyed promptly to clinical units, including the labour and delivery unit. (III-C) 2. At times of SARS outbreaks, all pregnant patients being assessed or admitted to the hospital should be screened for symptoms of and risk factors for SARS. (III-C) 3. Upon arrival in the labour triage unit, pregnant patients with suspected and probable SARS should be placed in a negative pressure isolation room with at least 6 air exchanges per hour. All labour and delivery units caring for suspected and probable SARS should have available at least one room in which patients can safely labour and deliver while in need of airborne isolation. (III-C) 4. If possible, labour and delivery (including operative delivery or Caesarean section) should be managed in a designated negative pressure isolation room, by designated personnel with specialized infection control preparation and protective gear. (III-C) 5. Either regional or general anaesthesia may be appropriate for delivery of patients with SARS. (III-C) 6. Neonates of mothers with SARS should be isolated in a designated unit until the infant has been well for 10 days, or until the mother's period of isolation is complete. The mother should not breastfeed during this period. (III-C) 7. A multidisciplinary team, consisting of obstetricians, nurses, pediatricians, infection control specialists, respiratory therapists, and anaesthesiologists, should be identified in each unit and be responsible for the unit organization and implementation of SARS management protocols. (III-C) 8. Staff caring for pregnant SARS patients should not care for other pregnant patients. Staff caring for pregnant SARS patients should be actively monitored for fever and other symptoms of SARS. Such individuals should not work in the presence of any SARS symptoms within 10 days of exposure to a SARS patient. (III-C) 9. All health care personnel, trainees, and support staff should be trained in infection control management and containment to prevent spread of the SARS virus. (III-A) 10. Regional health authorities in conjunction with hospital staff should consider designating specific facilities or health care units, including primary, secondary, or tertiary health care centres, to care for patients with SARS or similar illnesses. (III-A).

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

“…The literature search identified 987 articles. After title and abstract screening, 16 papers were selected for full‐text review; among those, there was one retrospective cohort study [14]; four case series [15‐18]; four case reports [19‐22]; and seven expert opinion articles [1, 12, 23‐27] (Table 1). Backward citation identified additional reports; however, the information relevant to regional anaesthesia was already presented in original papers in the initial search.…”

Emergency cesarean section in an epidemic of the middle east respiratory syndrome: a case report

“…We followed our institution protocol for patients with MERS and referred to the SARS obstetrics guidelines. According to the management guidelines for obstetric patients with SARS [ 12 ], all deliveries should be managed in a designated negative-pressure isolation room and by designated personnel with specialized infection control PPE.…”

Stillbirth During Infection With Middle East Respiratory Syndrome Coronavirus

“…With the currently limited knowledge about MERS-CoV epidemiology and pathophysiology, it is prudent to review observed associations between pregnancy outcomes and other severe respiratory pathogens. Complications such as maternal mortality and stillbirth have been reported among pregnant women with severe respiratory infections caused by SARS coronavirus (SARS-CoV) [ 4 ], influenza A virus subtype H1N1 [ 5 , 6 ], and other viruses causing pneumonia [ 7 ]. Uncomplicated pregnancies lead to physiologic changes resulting in altered pulmonary and immunologic function [ 8 , 9 ], including a 20% increase in maternal oxygen consumption, a 10%–25% decrease in functional residual capacity, and significantly increased forced vital capacity after 14–16 weeks gestation.…”