Maternal health care management during the outbreak of coronavirus disease 2019

Abstract

Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by 11 March, and the situation was characterized as a pandemic by the World Health Organization. Pregnant women are more susceptible to viral infection due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. Here, we present the managing processes of three pregnant women who had fever during hospitalization in the gynecology or obstetrics department, and then, we further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on the risk level, admission control, and measures counteracting emergencies and newly discovered high-risk cases at in-patient department. In the meantime, we will explain the alterations we have done throughout different stages of the epidemic and also review relative articles in both Chinese and English to compare our strategies with those of other areas. Although tens of COVID-19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant women registered in our hospital was reported to be infected.

Covid-19 and Pregnancy: An Overview

“…If a mother-to-be accesses first aid facilities or requires admission to a hospital with symptoms of an acute respiratory infection, it must be considered a suspected case. 35 A telephone triage is recommended if the mother is symptomatic or in self-isolation, and a clinical examination (where possible, and according to the degree of symptoms and fever) should be planned after several days. Mothers should be contacted by telephone for clinical follow-up with advice to alert the general practitioner if symptoms worsen.…”

Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

“…As the number of confirmed cases increases, evidence on the transmission, incidence, and effect of SARS-CoV-2 infection in mothers and their babies remains limited. Pregnant women are not thought to be more susceptible to the infection than the general population 23. However, changes to the immune system mean that pregnant women may be more vulnerable to severe infection 4.…”

Fetal Diagnosis and Therapy during the COVID-19 Pandemic: Guidance on Behalf of the International Fetal Medicine and Surgery Society

“…Restrictions on termination of pregnancy (TOP): where legally permitted, TOP is ethically justified when, following informed consent, a woman chooses TOP [4]. TOP is time sensitive and should never be classified as “elective,” even during a public health emergency [9, 3]. It follows that TOP restrictions, on the grounds of being allegedly “elective” by governments [10], organizations, or payers, are ethically unjustified.…”