| Antenatal management |
Patient will be admitted to isolation ward with negative-pressure room.
Teams to be activated upon admission to isolation ward
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Primary physician
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Maternal-fetal medicine team
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Neonatology team and pediatric infectious diseases team
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Pediatric intensive care unit team
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Anesthesia team
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Infectious diseases team
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Nursing team
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Operating theater team
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Medical social worker
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| If steroids administration is considered, the decision will be made following joint discussion by obstetrics, neonatology, and infectious disease teams. |
Items to be discussed and completed in the antenatal ward:
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The aim is normal vaginal delivery.
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Discuss with patient regarding the delivery process and postpartum care.
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To inform patient that baby will be separated immediately after delivery and will be admitted to PICU. COVID-19 testing will be carried out on the baby.
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If the test result is positive, the baby will stay with the mother.
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If the test result is negative, the baby will remain isolated.
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Consent forms for normal vaginal delivery, assisted vaginal delivery, and cesarean delivery need to be signed.
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Strongly recommend early epidural analgesia to minimize the need for general anesthesia in the event of emergency cesarean delivery.
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Informed consent for labor epidural analgesia needs to be preobtained and be reverified at time of procedure.
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Strictly no use of entonox due to the risk of aerosolization.
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| Intrapartum management |
Once labor starts, patient is to be transferred from the isolation ward to the isolation room in the delivery suite. If the isolation room in the delivery suite is not available, the patient will be transferred to the medical intensive care unit for delivery.
Teams to activate once patient arrives in delivery suite:
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Overall coordinator
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Primary obstetrician
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Neonatology team – consultant and neonatology registrar on call – who will contact pediatric infectious diseases and pediatric intensive care unit teams
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Anesthesia – obstetric anesthesia (epidural consultant on call)
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Operating theater nurse in charge
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Infectious diseases team consultant
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Coordinator for clinical sample collection
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Team to wear full PPE/PAPR during delivery in the isolation room in the delivery suite.
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Designated nurse assigned to the patient. Nurse in charge/sister is the second assistant.
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Medical staff to manage the case will be consultants and/or registrars and not junior residents.
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The practice of delay cord clamping and skin-to-skin bonding between the mother and newborn is not recommended.
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Should an emergency cesarean delivery be needed, designated operating room should be used. There are 2 designated operating rooms (operating room nurse in charge will inform the operating room upon being activated).
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Please refer to the routes from the delivery suite or medical ICU to operating theater.
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Clinical samples to be collected at the time of delivery (perinatal) – full PPE for sample collection. This may vary depending on clinical needs and facilities available at each center.
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High vaginal swab #1 – PCR
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High vaginal swab #2 – PCR
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Amniotic fluid (in specimen bottle) – PCR
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Maternal blood – 1 EDTA tube, 1 plain tube – PCR
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Umbilical cord blood – additional 1–2 mL for PCR (EDTA tube)
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Placenta – fetal surface swab (1 swab) – PCR
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Placenta – maternal surface swab (1 swab) – PCR
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Umbilical cord – external surface of the cord (1 swab) – PCR
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Umbilical cord – intravascular surface (1 swab, from inside UA or UV) – PCR
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Placenta – full-thickness biopsy (include fetal and maternal surfaces – to put stitch in maternal surface) – for histology
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Umbilical cord at the insertion site – full-thickness segment – for histology
Disposal of placenta – placenta is to be placed in triple biohazard bags before disposal. If cesarean delivery is performed, placenta is to be disposed in the Operating Theater.
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| Postpartum management |
After delivery:
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Baby will be immediately transferred to pediatric intensive care unit.
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Patient will be transferred back to the isolation ward.
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Transfer will be as per hospital protocol.
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Upon completion of transfer, medical and nursing staff need to shower and change to a new set of scrub uniform for the next case.
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Book cleaning team needs to disinfect the room as per infection control protocol (turnaround time: up to 3 hours for the next availability of bed).
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