NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date

SUMMARY:

This expert review provides some suggestions regarding best practices on labor and delivery during the COVID-19 pandemic. The following are highlights of interest to obstetric healthcare professionals (both staff and administration). The full document can be found in ‘Learn More – Primary Sources’

Triage Management

Screening Questions: Ask About the Following

• Symptoms
  • Presence of fever and/or respiratory symptoms
• Exposure Risk
  • Contact with person(s) suspected or known to be positive for COVID-19

If Patient is Symptomatic

• Severe (chest pain and/or shortness of breath)
  • Transfer to L&D for further evaluation
  • Use proper provider PPE
  • Flu and COVID-19 testing
• Mild (afebrile and new onset cough) or Moderate (New fever and new onset cough)
  • Acute OB concern: Transfer to L&D
  • No acute OB concern (e.g., anesthesia consult): Drive through testing | home quarantine | 24 follow up by phone

If Patient at Risk of Exposure

• Acute OB concern
  • Transfer to L&D
• No acute OB concern
  • Telehealth
  • Home quarantine

Admission Location

• Limit movement between units (i.e. triage and labor rooms)
• Women who are stable and are to be admitted for antepartum monitoring
  • If possible, keep patient in triage until transfer to antepartum floor

Respiratory Protection

• The authors recommend that the following should be the goal of L&D units due to asymptomatic transmission

…every patient wear a surgical mask and every provider have a surgical mask for each patient encounter

• Patient
  • Surgical mask (regardless of respiratory symptoms)
• Provider
  • During routine patient encounter: Surgical mask
  • Patient with upper respiratory tract symptoms: Droplet PPE (gown, gloves, surgical mask/face shield)
  • Patient who is suspected or confirmed COVID-19: Droplet PPE and N-95 mask
  • In presence of indispensable aerosolizing procedure: Droplet PPE and N-95 mask

Note: Second stage of labor is included in the “indispensable aerosolizing procedures” category

KEY POINTS:

Labor induction

• In keeping with professional recommendations, medical inductions should not be delayed
  • Authors include 39 week induction after counseling
• COVID-19 specific recommendations (authors stress importance of local circumstances)
  • Surge situation (extreme healthcare burden): “May be appropriate” to postpone or reschedule
  • Early COVID-19 phase: “May be prudent to get patients delivered prior to high COVID-19 burden”
  • Consider outpatient cervical ripening (e.g., Foley) for patients at low risk

First stage

• COVID-19 specific recommendations
  • Avoid peanut ball: Not shown to be effective | May transmit infection
  • Early intervention with oxytocin and amniotomy may be considered for women making slow progress | Higher oxytocin doses “can be considered”
  • Do not proceed to cesarean for first stage arrest unless
    • Arrest ≥4 hours with adequate uterine activity or
    • ROM: 6 hours with inadequate uterine activity, adequate oxytocin and cervical dilation ≥6 cm

Oxygen Therapy

• Authors recommend against use of oxygen for fetal resuscitation
  • No proven benefit
  • Potential risk for transmission via respiratory assist devices, including ventilatory masks

Nitrous Oxide

• Recommend eliminating use
  • Risk of transmission

Learn More – Primary Sources:

Expert Review: Labor and Delivery Guidance for COVID-19

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