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Table 3 Modifications to protocols for labour and childbirth

From: Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review

Airborne infection isolation rooms

• AGMPs can theoretically cause aerosolization of SARS-CoV-2, and therefore the use of airborne infection isolation rooms for the care of COVID-19 positive or suspected parturients is recommended if an AGMP is being performed [11, 15, 21, 35, 39, 42, 78, 82].

• [If available, one operating room with negative pressure and an anteroom should be marked exclusively for those with confirmed or suspected COVID-19, that needed emergency surgery.]

Visitors and birth-attendants

• Decisions should consider disease prevalence and regional/ cultural norms, the life-altering nature of the birthing experience and reports of increased stress and anxiety for pregnant persons with restrictive visitor policies [83, 84]. Options include (1) no visitors [35, 83], (2) one visitor who must leave following childbirth [15, 25, 34, 36, 72], and (3) one visitor for the duration of admission [4, 6, 39, 41, 46, 84, 85].

• All visitors should be screened and allowed only if they screen negative [4, 15, 46, 56].

• More accommodating visitor policies can be carefully introduced in the context of the available literature, which does not endorse support persons as a route of transmission of COVID-19 in hospitals [86].

• [Several guidelines recommend no visitors for parturients who are COVID-19 positive or suspected [4, 15, 46, 78].]

PPE for care providers

• For vaginal births, routine practice should include hand hygiene, wearing of gloves, protective eyewear and gowns [15, 40, 55, 56, 87]

• [In addition to routine measures, Droplet and Contact Precautions are recommended for care of known or suspected COVID-19 persons for non-aerosolizing medical procedures, such as the management of the first stage of labour [4, 6, 41, 53, 88]. Since it is unclear whether forceful exhalation in the second stage of labour has the potential to generate aerosols, most guidance suggest using N95 respirators for vaginal birth of a COVID-19 positive or suspected person, if available [34, 35, 55, 89, 90]].

The use of masks by parturients

• Decisions depend, to some extent, on the universality of testing prior to admission. The universal use of masks by all parturients throughout admission [18, 39, 55, 56] may not be necessary, although it should be considered during transfers [50], and in all public areas. This protects others, while ensuring the comfort of the parturient during the extended stay and in active labour.

• [Wearing of masks by those positive or suspected of COVID-19 should be encouraged [6, 40,41,42].]

Intrapartum fetal monitoring

• Continue as indicated by local policy and clinical indication.

• [Continuous electronic fetal monitoring has been recommended for symptomatic parturients with confirmed or suspected COVID-19, but not for asymptomatic or mild cases [53].]

Management of the second stage of labour

• Continue according to local policy and clinical indication.

• [Although operative vaginal delivery has been recommended to reduce the duration of active pushing and forceful exhalation that could risk spread of infection [18, 34, 42, 56, 78], ,there is no clinical justification for this practice, unless the parturient has considerable respiratory distress.]

Emergency caesarean deliveries

• Although the indications for emergency caesareans remain unchanged, consideration must be given to additional time required for donning PPE and the risk posed by intubation at the time of dire emergencies [34, 76].

• Involvement of the senior most anaesthesia and obstetric staff could minimize complications and reduce the need for repeat operation [76].

• Consider avoiding staples for skin closure, to reduce additional follow-up for their removal [50].

  1. [Italicized text] indicates suggestion for those with suspected or confirmed COVID-19
  2. AGMP Aerosol-generating medical procedure, SARS-CoV-2 Severe Acute Respiratory Syndrome-related coronavirus 2, PPE Personal protective equipment