Covid-19 and Labor & Deliveries

[Campanella]

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Labor and Delivery is definitely a unique unit in the hospital that deals with unique patients, even in ordinary times. But these are not ordinary times. I'm wondering what measures y'all's shops are taking to prepare for a surge in Covid-19 cases. There's not really a standard playbook for dealing with this type of crisis in the modern US, especially as it pertains to pregnant patients, so we can hopefully share some good ideas.

 

[anonperson]

Labor and Delivery is definitely a unique unit in the hospital that deals with unique patients, even in ordinary times. But these are not ordinary times. I'm wondering what measures y'all's shops are taking to prepare for a surge in Covid-19 cases. There's not really a standard playbook for dealing with this type of crisis in the modern US, especially as it pertains to pregnant patients, so we can hopefully share some good ideas.

Visitation has been severely restricted. We are running short on alcohol based hand cleaners so now hand washing is what is recommended.

We have some protocols in place for patients suspected of coronavirus including newborn management. None of it is particularly interesting, just isolating patient etc.

We have 2 specific laboring rooms and 2 antepartum rooms for them as well.

We used to see pregnant patients in triage even if they had non obstetric complaints. They will now get punted to the ED.

But at this point, there is not much else. No specific treatment or vaccine at this time. I read some of the data out of China. Of the handful of pregnant women with the infection, they ultimately did well. One newborn transmission from what I recall.

My main concern is transmission to healthcare workers (physicians/nurses/techs etc). If we get infected, that takes us out for awhile and limits our ability to care for patients and causes significant downstream effects.

 

[Campanella]

Visitation has been severely restricted. We are running short on alcohol based hand cleaners so now hand washing is what is recommended.

We have some protocols in place for patients suspected of coronavirus including newborn management. None of it is particularly interesting, just isolating patient etc.

We have 2 specific laboring rooms and 2 antepartum rooms for them as well.

We used to see pregnant patients in triage even if they had non obstetric complaints. They will now get punted to the ED.

But at this point, there is not much else. No specific treatment or vaccine at this time. I read some of the data out of China. Of the handful of pregnant women with the infection, they ultimately did well. One newborn transmission from what I recall.

My main concern is transmission to healthcare workers (physicians/nurses/techs etc). If we get infected, that takes us out for awhile and limits our ability to care for patients and causes significant downstream effects.

We're taking the same precautions; hopefully the reduce unnecessary spread. Our hospital has also adopted an algorithm for administering the test for Covid-19, but it has a general statement about immunocompromise without taking pregnancy status into account. We're working on adding that to the algorithm.

 

[anonperson]

We're taking the same precautions; hopefully the reduce unnecessary spread. Our hospital has also adopted an algorithm for administering the test for Covid-19, but it has a general statement about immunocompromise without taking pregnancy status into account. We're working on adding that to the algorithm.

We are experiencing at least 5 to 7 day turnaround time with tests via Quest. Ridiculous.

 

[Naruhodo]

So the COVID-19-related issue that my partner and I are experiencing is that OBGYN/CNM offices locally seem not to be open/returning phone calls to book an initial prenatal evaluation. We're obviously not super eager to be interacting a ton with the healthcare system either in the midst of this pandemic, but, you know, believe there is a reason we have prenatal care? How long do you think it's safe to wait to hear anything? 8 weeks post-LMP? 10 weeks? 12 weeks? Show up during the second trimester? (Joking, I think...)

 

[allantois]

So the COVID-19-related issue that my partner and I are experiencing is that OBGYN/CNM offices locally seem not to be open/returning phone calls to book an initial prenatal evaluation. We're obviously not super eager to be interacting a ton with the healthcare system either in the midst of this pandemic, but, you know, believe there is a reason we have prenatal care? How long do you think it's safe to wait to hear anything? 8 weeks post-LMP? 10 weeks? 12 weeks? Show up during the second trimester? (Joking, I think...)

some people show up an hour before delivery

 

[Naruhodo]

some people show up an hour before delivery

Fair enough, but I still don't think that's the *recommended* course of action. Just not sure what we should be doing here that we're not (other than continuing to try to call farther afield). I've heard epidemiologists predict COVID-19 infections should peak within the next 2 weeks for our area, so maybe after that some of these offices will start opening up/ responding to voicemails?

 

[anonperson]

So the COVID-19-related issue that my partner and I are experiencing is that OBGYN/CNM offices locally seem not to be open/returning phone calls to book an initial prenatal evaluation. We're obviously not super eager to be interacting a ton with the healthcare system either in the midst of this pandemic, but, you know, believe there is a reason we have prenatal care? How long do you think it's safe to wait to hear anything? 8 weeks post-LMP? 10 weeks? 12 weeks? Show up during the second trimester? (Joking, I think...)

If you wait too long, you will be out of range for certain genetic screening/nuchal translucency measurement. But non invasive testing could be done at any time as well.

If that isn't a concern then you have some time.

But again, depends on other co morbid conditions (DM, HTN) etc

 

[Dr. Death]

There's a group of providers where we're from originally that won't see a normal IUP until 12 weeks

 

[Naruhodo]

Update: Pretty sure we've had a 1st trimester miscarriage. At least it was before we announced the pregnancy to our friends and family and given the situation with trying to find prenatal care around here during the COVID-19 crisis, it may well be for the best. Thanks for weighing in with thoughts/suggestions.

 

[Dr. Death]

Update: Pretty sure we've had a 1st trimester miscarriage. At least it was before we announced the pregnancy to our friends and family and given the situation with trying to find prenatal care around here during the COVID-19 crisis, it may well be for the best. Thanks for weighing in with thoughts/suggestions.

I'm sorry about your loss.

 

[Laradd]

Its like normal transition you'll do before delivery just make sure to follow social distancing, and wearing mask is a must still.

 

[anonperson]

Recent changes:

Physicians and nurses to wear N95 masks at all deliveries .

Patients to wear regular masks at all times

Temporarily suspended skin to skin. (To avoid nurse being right by patient's head). They are taking baby to warmer in room and after assessing baby they take baby to mom. So a couple of minutes delay.

This caused some controversy among some people in the department but I think it's a reasonable measure for now until things calm down a bit.

 

[Campanella]

Recent changes:

Physicians and nurses to wear N95 masks at all deliveries .

Patients to wear regular masks at all times

Temporarily suspended skin to skin. (To avoid nurse being right by patient's head). They are taking baby to warmer in room and after assessing baby they take baby to mom. So a couple of minutes delay.

This caused some controversy among some people in the department but I think it's a reasonable measure for now until things calm down a bit.

We're not requiring N95 masks for all deliveries yet, but we are requiring patients to wear regular masks at all times. We have limited the number of people attending deliveries in order to reduce potential exposure and conserve PPE.

 

[raiderette]

So very sorry.

Update: Pretty sure we've had a 1st trimester miscarriage. At least it was before we announced the pregnancy to our friends and family and given the situation with trying to find prenatal care around here during the COVID-19 crisis, it may well be for the best. Thanks for weighing in with thoughts/suggestions.