Labor and delivery guidance for COVID-19

Rupsa C Boelig, Tracy Manuck, Emily A Oliver, Daniele Di Mascio, Gabriele Saccone, Federica Bellussi, Vincenzo Berghella, Rupsa C Boelig, Tracy Manuck, Emily A Oliver, Daniele Di Mascio, Gabriele Saccone, Federica Bellussi, Vincenzo Berghella

Abstract

This document addresses the current coronavirus disease 2019 (COVID-19) pandemic for providers and patients in labor and delivery (L&D). The goals are to provide guidance regarding methods to appropriately screen and test pregnant patients for COVID-19 prior to, and at admission to L&D reduce risk of maternal and neonatal COVID-19 disease through minimizing hospital contact and appropriate isolation; and provide specific guidance for management of L&D of the COVID-19-positive woman, as well as the critically ill COVID-19-positive woman. The first 5 sections deal with L&D issues in general, for all women, during the COVID-19 pandemic. These include Section 1: Appropriate screening, testing, and preparation of pregnant women for COVID-19 before visit and/or admission to L&D Section 2: Screening of patients coming to L&D triage; Section 3: General changes to routine L&D work flow; Section 4: Intrapartum care; Section 5: Postpartum care; Section 6 deals with special care for the COVID-19-positive or suspected pregnant woman in L&D and Section 7 deals with the COVID-19-positive/suspected woman who is critically ill. These are suggestions, which can be adapted to local needs and capabilities.

Keywords: COVID-19; coronavirus; obstetric protocol; pandemic.

© 2020 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Flowchart for triaging patients who call into labor and delivery. COVID-19, coronavirus disease 2019; PPE, personal protective equipment Boelig et al. Labor and delivery guidance for COVID-19. AJOG MFM 2020.
Figure 2
Figure 2
Suggested flow for screening patients presenting to labor and delivery triage. COVID-19, coronavirus disease 2019; PPE, personal protective equipment Boelig et al. Labor and delivery guidance for COVID-19. AJOG MFM 2020.
Figure 3
Figure 3
Flow chart for roles, equipment, and PPE in preparation for a cesarean delivery of COVID-positive patient COVID, coronavirus disease; OB, obstetrician; OR, operating room; PPE, personal protective equipment; RN, registered nurse. Boelig et al. Labor and delivery guidance for COVID-19. AJOG MFM 2020.

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