Ensuring Maternal & Infant Safety During The Outbreak of - - PowerPoint PPT Presentation

北京大学第三医院

Peking University Third Hospital

Peking University Third Hospital OB&GYN Department

Jie Qiao

Ensuring Maternal & Infant Safety During The Outbreak of COVID-19 —Recommendations

Pandemic Situation of COVID-19 World Wide

Updated：As of 9:12 AM, Apr 01, 2020 GMT

859032 42,322 203 178,101

Recovered

Not Numbers, But Lives

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Pandemic Situation of COVID-19 World Wide

Resource：WHO 2 1 3 4 5 6 7 8 9 10

81%

Top 10 countries of confirmed cases Until 1 April

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Resource：WHO

Pandemic Situation of COVID-19 World Wide

Countries, areas,or territories with COVID-19 cases reported in the last 7days, as of 31 March,2020

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团结/奉献/求实/创新

Resource：WHO

Pandemic Situation of COVID-19 in China

Updated：17:36 PM, Apr 01, 2020 Beijing me

Confirmed cases Deaths Imported cases Recovered

82,691 3,321 806 76,419

100000 80000 60000 40000 20000

confirmed cases Suspected cases Existing cases

Timely corresponding at "the early stage"

Three groups of national medical teams sent by PUTH to support Wuhan

• Critically ill cases Cure
• Maternal & Infant Safety

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Three hospitals of Peking University set up ICU in Tongji Medical College of HUST on February 2

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Hotspots of Maternal & Infant Safety During The Outbreak of COVID-19

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Major Concerns from

Risk of expose and infection?

At community, and during routine checkups

Prenatal checkup schedule?

Which is necessary, or can be reduced/remove?

Safe Delivery?

How to avoid transmission in Hospital?

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Pregnant women And Ob speclialists

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• Prevention procedures: Home quarantine, avoid close

contact, wear mask, wash hands, sanitize the room, etc.

• Self-monitoring: adverse symptoms related to COVID-19

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Uninfected Reducing the Risk of expose and infection

团结/奉献/求实/创新

Prenatal Checkup Recommendations

Online approaches should be encouraged to provide health education and counseling for pregnant women

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Uninfected

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• Routine Screening: Epidemic history, signs & symptoms,

antibodies… for patient and her family, if positive, isolate immediately.

• Safe distance between patients:

Avoid crowds, less patient in one room

• Shorter hospital stays
• Patient education: Postpartum Care, especially protection
• Follow the infection control orders strictly (for hospital)

Safe Delivery

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Uninfected

Empty Empty

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Situation of Infected Pregnant women in China

infected infected

It is suggested to go to the designated midwifery medical institutions for treatment as soon as possible

For suspected or confirmed pregnant women，

 There are 1654 designated hospitals provide medical services for infected women in China.

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Major Concerns

• Screening for suspected patient
• Management if infected during first/second/third

trimester?

• Choice of delivery mode: Vaginal delivery or CS
• Postpartum care
• Protection of neonates
• Protection of medical staff

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from uninfected Pregnant women And Ob speclialists

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infected

Screening during admission

• Epidemiological screening (Cloud computing and bid data approaches)
• Signs and symptoms: Fever, cough, short breath, diarrhea, Fatigue, etc.
• Blood tests: CBC(Lymph cell counts, etc.), NCV antibodies(IgG, IgM) ,
• If necessary: Nucleoid acid and CT scan.
• If suspected: Quarantine the patient in specific room as soon as possible.
• Multidisciplinary Consults

infected

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infected

Treatment Recommendations

• 1. The suspected/infected patient should be quarantined to

isolated room immediately

• 2. Multidisciplinary consultation is needed to give a systematic

treatment plan.

• 3. No evidence supporting the termination of pregnancy without

medical indications.

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infected

• 4. Pregnant women with severe or critical COVID-19 should

terminate pregnancy, and the best choice is caesarean section

• 5. Refer the confirmed patients to designated hospital for more

precise treatment, if the condition allows

• 6. Use proper protection when contacting the patient.

Treatment Recommendations

Whether there is vertical transmission from mothers to babies?

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Tip: the possibility of supporting vertical transmission

Can SARS-CoV-2 be transmitted in utero？

Point 1: Point 1: Have possible Have possible

The mother was suffering from

• coronavirus. The antibody of SARS-CoV-2

IgM was increased and the cytokine test was abnormal in the newborn 2 hours after birth Among the six confirmed mothers of COVID-19, 5 infants had elevated IgG concentration of SARS-CoV-2, and IgM was detected in 2 infants

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团结/奉献/求实/创新

However, whether the case is a vertical transmission from mother to child remains to be confirmed. It is very important to shorten the delivery time of fetus and minimize the contact between fetus and maternal blood and body fluid during cesarean section. A case of neonatal COVID-19 infection in China with pharyngeal swabs tested positive by rRT-PCR assay 36 hours after birth.

Can SARS-CoV-2 be transmitted in utero？

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Point 1: Point 1: Have possible Have possible

团结/奉献/求实/创新

Point 2: Not Sure Point 2: Not Sure

Can SARS-CoV-2 be transmitted in utero？

• 9 confirmed pregnant women all in third trimester
• Delivery: all cases had a caesarean section
• 6 newborns having tests for SARS-CoV-2:

amniotic fluid, cord blood, breast milk, neonatal throat swab samples (All samples tested negative for the virus)

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团结/奉献/求实/创新

Point 2: Not Sure Point 2: Not Sure

Can SARS-CoV-2 be transmitted in utero？

Published Online February 10, 2020

• Sample: 9 mothers (10 neonates)
• Delivery: 2 vaginal deliveries (1 twin-

case)+ 7 caesarean sections

• Neonatal outcomes: fetal distress (7/10),

premature labor (4/10), respiratory distress (2/10), thrombocytopenia accompanied by abnormal liver function (2/10), death (1/10).

• All neonatal pharyngeal swab samples

were tested negative for the virus.

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IgM assays can be prone to false- positive and false-negative results the rapid decline reported in this patient could represent artifact

• 2h after birth

IgM 45.83 AU/ml

• 14d after birth IgM 11.75 AU/ml

Neonatal COVID-19 nucleic acid test negative Point 2: Not sure Point 2: Not sure

Can SARS-CoV-2 be transmitted in utero？

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团结/奉献/求实/创新

more definitive evidence is needed

Yes No

Time

Can SARS-CoV-2 be transmitted in utero？

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infected Infection Prevention Risk During Vaginal Birth

• Decreased body resistance due to physical exhaustion during labor.
• Increased infection prevention and control difficulty due to hyperventilation,

amino fluids, vaginal bleeding, and vaginal discharge.

• If emergency CS needed, infection prevention procedures are hard to

implement rapidly

infected

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infected Delivery and Post Partum Recommendations

• 1. Labor and delivery should be performed in a designated negative

pressure isolation room; and managed by designated personnel with specialized infection control preparation and protective gear. 2.Neonates of mothers with COVID-19 should not be breastfed until the mother’s isolation period is complete.

• 3. Neonates of mothers with COVID-19 should be isolated in a designated

unit for at least 14 days after birth.

• 4. Maternal and neonatal follow-ups should be done to evaluate their safety

and health.

Practices in China

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Isolation Categories of Pregnancy Women

Home－isolation

Normal pregnancy women Suspected cases/ Confirmed mild cases Confirmed severe cases Fangcang shelter hospital Or Ob & Gy Hospital Ob & Gy Hospital Or designated hospitals managed by the national medical specialists team

regular prenatal examination

Maternal and Child Hospital of Hubei province Peking University Third Hosptial

Delivery number：70-80/d Delivery number：10-20/d Most of themare severe cases

• Isolate sources of infection
• Cut off transmission routes
• Close observation of patients
• Adjusting the therapy in time

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Emergency plans and infection control procedures

CS contingency plan Delivery management Post-delivery Sample collection

Exclusive transfer unit (re: PUTH)

Emergency delivery

“Closed loop process”

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Prevention Drill Regardless of Delivery Mode Regardless of Delivery Mode

Infection Control is Crucial!

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DRILL!

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• Sample: 2002 pregnant women (183 community health centers and 67

hospitals)

• Methods: questionnaires
• Main Results: 94.6% worried about being infected

14.7% demanded for psychological consultation 71.0% would like to obtain knowledge & consultations through online APPs

Psychological intervention

Psychological intervention and support is very important for pregnant women during the outbreak of COVID-19.

团结/奉献/求实/创新

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 Early i identif ificat ation  Ear arly y reporting  Ear arly y is isolat ation  Ear arly y treat atment  Protection o

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Critical issues for protecting pregnancy women

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The overall arrangements

National policies and technical guidelines Optimize the operation of MCH service system

A Nation' s War on the Epidemic

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The overall arrangements-Share information at first time

Share information at first time

A Nation' s War on the Epidemic

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