Delivery management of suspected or confirmed COVID-19 positive mothers

Abstract

The Coronavirus Disease-2019 (COVID-19) pandemic has brought catastrophic impact on the world since the beginning of December 2019. Extra precautionary measures against COVID-19 during and after delivery are pivotal to ensure the safety of the baby and health care workers. Based on current literature, it is recommended that delivery decisions be discussed between obstetricians and neonatologists prior to delivery, and designated negative pressure delivery rooms should be arranged for COVID person under investigation (PUI). During delivery, a minimal number of experienced staff attending delivery should don personal protective equipment (PPE) and follow the neonatal resuscitation program (NRP). Positive pressure ventilation is best used in a negative pressure room if available. At-risk babies should be transported in an isolette, and tested for COVID-19 in a negative pressure room soon after bathing. Skin-to-skin contact and breast milk feed should continue under certain circumstances. Although newborns with COVID-19 infections often present with symptoms that mimic sepsis and one third of affected patients may demand some form of respiratory support, short-term prognoses are favorable and most recover within two weeks of symptoms onset. In this article, we will further elaborate on topics covering timing and mode of delivery, antenatal steroid, vertical transmission, delivery room management, airway management, transport, testing and isolation after birth, skin-to-skin contact, breast milk feeding, clinical features, outcomes, and discharge plans. In addition, we also share our experiences of encountering neonates born of suspected COVID-19 positive mothers.

Optimal Delivery Management for the Prevention of Early Neonatal SARS-CoV-2 Infection: Systematic Review and Meta-analysis

“…15,16 DMIs that encourage cesarean section with its known risks to mothers, separate the delivery environment from the infant resuscitation environment, decrease motherinfant bonding by preventing skin-to-skin, and disrupt known benefits of delayed bathing in infants continue to be practiced without clear evidence of their effectiveness in preventing ENI and ND. 17 Sunuwar et al described a small retrospective review of 104 women who were SARS-CoV-2-positive during any trimester of pregnancy and delivered by vaginal delivery or cesarean section and followed their neonatal outcomes. 18 They found that in their infants 51% were born with low Apgar scores, 18% were born prematurely, 19% had low birth weight, 7% required neonatal intensive care unit admission, 3% experienced neonatal asphyxia, 2% died, and none were SARS-CoV-2-positive.…”

“…Current reviews continue to combine discussions of DMI along with antepartum and postpartum care without evidence to direct DMI. 17,20 It is difficult to distinguish the risks of SARS-CoV-2 transmission attributable to antepartum care compared with postnatal delivery management. Between 1 and 15% of adults with COVID-19 have RNAaemia and pregnant women are more susceptible to COVID-19 than the general population.…”

COVID-19 Pandemi Süreci ve İntrapartum Dönemde Bakım

“…(15) Obstetrik endikasyonlar dışında yapılan sezaryen doğumlarda maternal morbidite riski arttıran bir faktördür. (7) Sezaryen ile doğum, annenin klinik durumunda hızlı bozulma, akut organ yetmezliği, septik şok, gebe uterusa bağlı mekanik ventilasyonda zorluk ve fetal distres gelişmesi halinde uygun olacaktır. (15) Doğum şekline gebe bireysel olarak değerlendirildikten sonra karar verilir ve doğum izole odalarda uygun kişisel koruyucu ekipman giymiş ekip tarafından gerçekleştirilmesi gerekmektedir (11,13).…”

“…COVID-19 enfekte gebenin yanında refakatçi kalmasına izin verilmemelidir. (2,7,12) Bilindiği gibi doğum sırasında kadının, nabız, tansiyon, sıcaklık, oksijen satürasyonu gibi yaşamsal parametreleri her 3-4 saatte bir değerlendirilmesi gerekmektedir. Ayrıca SPO2 %94'ün altına düşerse arteryel kan gazı alınarak PaO2 bakılmalı, oksijen desteği sağlanmalıdır.…”

“…(6) Bu nedenle, doğum sırasında ve sonrasında COVID-19'a karşı ekstra önlemlerin alınması, bebeğin ve sağlık çalışanlarının güvenliğini yönünden elzemdir. (2,7) COVID-19 pandemisi ile birlikte anne ve yenidoğan sağlığı hizmetlerine erişimde güçlükler olması antepartum, intrapartum ve postpartum dönem maternal, fetal mortalite ve morbiditede artışlara neden olmaktadır. (8) COVID-19 pandemisi nedeniyle anne ve yenidoğan sağlık hizmetlerine erişimin azalmasının mortalite üzerindeki potansiyel etkisini tahmin eden Guttmacher Enstitüsü tarafından yapılan çalışmada, gebelik ve yenidoğana yönelik sunulan sağlık hizmetleri kapsamında %10'luk bir düşüşün, dünya genelinde ek 28.000 anne ölümü, 168.000 yenidoğan ölümü ve 1.745.000 majör obstetrik komplikasyon ile sonuçlanabileceğini göstermektedir.…”