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Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel.
Am J Obstet Gynecol. 2020 Jul; 223(1):66-74.e3.AJ

Abstract

Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient.

Authors+Show Affiliations

Department of Anaesthesia, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: ashokkab@gmail.com.Department of Anaesthesia, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Centre for Infectious Diseases, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Centre for Infectious Diseases, Singapore.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore.Department Obstetrics & Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile.Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics & Gynaecology, National University Hospital, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32283073

Citation

Ashokka, Balakrishnan, et al. "Care of the Pregnant Woman With Coronavirus Disease 2019 in Labor and Delivery: Anesthesia, Emergency cesarean Delivery, Differential Diagnosis in the acutely Ill Parturient, Care of the Newborn, and Protection of the Healthcare Personnel." American Journal of Obstetrics and Gynecology, vol. 223, no. 1, 2020, pp. 66-74.e3.
Ashokka B, Loh MH, Tan CH, et al. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol. 2020;223(1):66-74.e3.
Ashokka, B., Loh, M. H., Tan, C. H., Su, L. L., Young, B. E., Lye, D. C., Biswas, A., Illanes, S. E., & Choolani, M. (2020). Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. American Journal of Obstetrics and Gynecology, 223(1), 66-e3. https://doi.org/10.1016/j.ajog.2020.04.005
Ashokka B, et al. Care of the Pregnant Woman With Coronavirus Disease 2019 in Labor and Delivery: Anesthesia, Emergency cesarean Delivery, Differential Diagnosis in the acutely Ill Parturient, Care of the Newborn, and Protection of the Healthcare Personnel. Am J Obstet Gynecol. 2020;223(1):66-74.e3. PubMed PMID: 32283073.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. AU - Ashokka,Balakrishnan, AU - Loh,May-Han, AU - Tan,Cher Heng, AU - Su,Lin Lin, AU - Young,Barnaby Edward, AU - Lye,David Chien, AU - Biswas,Arijit, AU - Illanes,Sebastian E, AU - Choolani,Mahesh, Y1 - 2020/04/10/ PY - 2020/3/25/received PY - 2020/4/3/revised PY - 2020/4/3/accepted PY - 2020/4/14/pubmed PY - 2020/7/11/medline PY - 2020/4/14/entrez KW - ACE2 KW - ARDS KW - COVID-19 KW - MERS KW - SARS KW - SARS-CoV-2 KW - acute respiratory distress syndrome KW - acutely ill KW - coronavirus KW - coronavirus disease 2019 KW - maternal morbidity KW - obstetric management KW - pandemic KW - pregnancy KW - severe acute respiratory syndrome KW - vertical transmission KW - virus SP - 66 EP - 74.e3 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 223 IS - 1 N2 - Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/32283073/Care_of_the_pregnant_woman_with_coronavirus_disease_2019_in_labor_and_delivery:_anesthesia_emergency_cesarean_delivery_differential_diagnosis_in_the_acutely_ill_parturient_care_of_the_newborn_and_protection_of_the_healthcare_personnel_ DB - PRIME DP - Unbound Medicine ER -