Table 1.
Professional Society Recommendations for Labor and Delivery Comparison of Recommendations for Intrapartum Anesthetic Care of Known or Suspected COVID-19 Patients
| SOAP | ACOG | SMFM-SOAP | SOGC | RANZCOG | RCOA-OAA | RCOG | |
|---|---|---|---|---|---|---|---|
| Initial publication | March 15, 2020 | March 23, 2020 | March 25, 2020 | March 17, 2020 | March 23, 2020 | March 16, 2020 | March 15, 2020 |
| Date updated | March 23, 2020 | March 26, 2020 | March 27, 2020 | March 26, 2020 | March 29, 2020 | March 27, 2020 | March 28, 2020 |
| Isolation room | Yes, preferably negative pressure | - | Yes, negative pressure for AGP | - | Yes | - | Yes |
| Mask on patient | - | Yes, surgical | Yes, surgical | Yes, surgical | Yes, surgical | Yes, surgical | Yes, surgical |
| Visitors and support people | Limit visitors and support people | Limit visitors and support people | Limit or eliminate visitors, special considerations apply | Yes, single asymptomatic | Yes, limited, asymptomatic | - | Yes, single asymptomatic, limit visitors to wards |
| PPE for non-AGP, first stage labor | Droplet and contact | Droplet and contact, airborne preferred | Droplet and contact | Droplet and contact | - | - | Droplet and contact |
| PPE for vaginal delivery, second stage labor | Droplet and contact | Droplet and contact, airborne preferred | Airborne reasonable, consider surgical drapes as additional barrier | Droplet and contact, consider airborne if risk of sudden deterioration | - | - | Droplet and contact |
| PPE neuraxial analgesia | Droplet and contact | Droplet and contact, airborne preferred | - | - | - | Droplet and contact | - |
| Neuraxial analgesia and anesthesia COVID-specific concerns | Labor analgesia encouraged early; performedby most experienced provider | - | Labor analgesia encouraged early | Labor analgesia encouraged early; performedby most experienced provider | - | Labor analgesia encouraged early, suggestion to check platelet count | Labor analgesia encouraged early |
| Use of nitrous oxide | Consider suspending use | - | Consider suspending use | - | Yes, no evidence of AGP, use filter | Yes, no evidence of AGP, use filter | Yes, no evidence of AGP, use filter |
| Use of postoperative NSAIDs | Data lacking, likely safe if asymptomatic | Data lacking | Data lacking, continue to use in asymptomatic and mildly symptomatic patients | - | - | - | - |
| Mode of delivery | - | Per obstetric indications | - | Per obstetric indications | Per obstetric indications | - | Per obstetric indications, no water births |
| Operative delivery | - | Follow usual clinical indications | Not precluded, consider performing in OR | - | - | - | Individualized decision |
| Elective cesarean or induction of labor with current COVID-19 infection | - | - | - | - | Preferable to delay until completion of isolation period, if possible | - | Evaluate safety of delaying procedure |
| PPE for cesarean delivery | Anesthesia team: droplet, contact, ideally airborne; ifGA planned: all staff wear airborne, minimize staff in room at time of intubation and extubation |
Ideally airborne for all staff | Ideally airborne for all staff for all cases | Airborne advised; if GA planned: all staff wear airborne, minimize staff in room at time of intubation and extubation |
- | Neuraxial planned (and low risk of GA): droplet and contact; emergency cesarean: as above, risk assess need for airborne PPE; if GA planned: airborne PPE for all staff in room during intubation and extubation, minimize staff present, airborne for all staff if no time to allow for air turnover |
Neuraxial planned (and low risk of GA): droplet, scrubbed staff waits outside of room until block successful; emergency cesarean: droplet for neuraxial, airborne if risk of GA; if GA planned: airborne for all staff |
Abbreviations: ACOG, xxx; AGP, xxx; COVID-19, Coronavirus disease 2019; GA, xxx; NSAIDs, nonsteroidal anti-inflammatory drugs; OR, xxx; PPE, personal protective equipment; RANZCOG, xxx; RCOA-OAA, xxx; RCOG, xxx; SMFM-SOAP, xxx; SOAP, xxx; SOGC, xxx.