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HMCN - Maternity and Newborn Services Response to COVID-19
7/7/2020
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This guideline has been created in collaboration between the Obstetric, Paediatric and Anaesthetic
Departments within HMCN and with assistance of the GM, DMS, DON, DDON and Infection Control
at HMCN. It is intended for use at Port Macquarie Base and Kempsey District Hospitals ONLY.
Please refer to the following sites which will provide the bulk of information:
• MNCLHD COVID-19 intranet
• NSW Health – Provides general advice regarding COVID-19 as advised by NSW health
• MNCLHD Maternity Service – provides general advice regarding maternity services
• Maternity and newborn care - Communities of practice – clearly describes essentials of
care, antenatal, intrapartum and post partum care for women at low risk of COVID – 19 and
also those with suspected / confirmed COVID - 19
Principles of care • All staff, women and visitors presenting to hospital for any reason must be screened by
having their temperature checked and asked questions approved as per NSW Health
• Visitors – as per current MNCLHD guidelines
• Staff and visitors are required to follow infection control - PPE and hand washing
appropriate to the clinical contact
• Minimise support people at AN Clinic appointments where possible – refer to MNCLHD
recommendations
• Consider where appropriate telehealth for some antenatal and post natal outpatient care
• Each Maternity Unit must have a designated isolation space for – antenatal, labour and post
natal encounters of COVID-19 positive / suspected women
• Appropriate ongoing antenatal care must be provided to COVID-19 positive/suspected
women – tailor care to the patients individual needs and risks – utilise telehealth were
appropriate
• Early discharge of women with Covid -19 is NOT to be encouraged (advice of MoH as of 23rd
April 2020). Those women who wish to be discharged early and who are suitable should
only be discharged when appropriate support at home is in place. Aim for all newborn
checks to be done prior to discharge.
Childbirth and Parenting Education As a precaution to minimise the risk of transmission of COVID-19 all face to face childbirth and
parenting education sessions have been cancelled, they will be recommenced with considered safe
to do so. Telehealth alternatives have been created.
Women may also be directed to online resourses –available on the Mothers and Babies Recourses
section of the MNCLHD public website MNCLHD Maternity Service.
Planned antenatal and outpatient post natal care All women are to be verbally screened for symptoms and risk factors for COVID-19 prior to
presentation (SMS or phone call) and screened again on arrival. They will also have temperature
checked on arrival at entry points of the hospital.
Refer to NSW Health website resources for the most up to date advice as to who is considered a
suspected case or at risk of COVID-19 and the screening questions required.
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Provide patients with resources for advice and clinical review if needed: GP, MNCLHD COVID
screening clinics, ED, Health Direct 1800 022 222 as required
• Visits will be provided as a mixture of face to face and telehealth (or a combination if
needed) as clinically appropriate in accordance with advice from NSW Health.
• Ensure COVID safe social distancing in waiting areas
• Refer to Maternity and newborn care - Communities of practice for advice regarding the
minimum requirements for antenatal care – these visits are considered essential and
additional visits should be provided where required based on the woman’s risk and the
degree of COVID-19 infection in our community.
• At time of release of the guideline visits for low risk women at will be
o Booking – face to face (unless woman requests telehealth)
o 20 weeks – face to face (telehealth would be reasonable if low risk and woman
already attended a face to face booking in visit)
o 24 – face to face – consider telehealth for low risk multiparous women
o 28 – face to face
o 32 – face to face
o 34 – face to face
o 36 – face to face
o 38 – face to face
o 39 – face to face but may be omitted if low risk multip
o 40 weeks – face to face
o Reduction in visits to the NSW Health Minimum standards (booking, 20, 38, 36, 40)
may be required in the peak of a pandemic.
• Ensure Boosterix (20 weeks onwards) and Influenza vaccination (any gestation) is offered
• Reduce face to face post natal reviews – use telehealth or refer to GP as appropriate
• Refer to flow charts at the end of this document for management of women within the
Home Midwifery Service
• Individualise care of women who are suspected / confirmed COVID-19
o Routine face to face care should NOT occur in these women until they have been
released from self isolation at the advice of the Respiratory Team at PMBH
o Use telehealth to provide care and triage to face to face care as required
o Non routine care to occur as clinically indicated – isolate & PPE precautions
• Women with respiratory symptoms / fever should not be seen in ANC, use telehealth or
rebook or review in a suitable isolation room (if review required) and advise the woman to
present to the COVID Clinic for swabbing
• Ensure women who’s care is deferred are followed up
Antenatal care/procedures for confirmed /suspected COVID-19: • If >36 weeks consider a full handover of care to Port Macquarie Base Hospital if the
woman is booked at Kempsey District Hospital. This in an attempt to keep KDH
COVID free.
• If <36 weeks resume usual antenatal care after 14 days symptom free or negative
test result and as advised by the respiratory / public health team caring for the
woman
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• Care of COVID / Suspected COVID women - remain in contact with the patient,
phone consultations, telehealth and where absolutely required face to face –
suitable location and using PPE
• Ultrasound fetal growth surveillance 14 days following resolution of acute illness.
Advice for pregnant women who are required to self-isolate at home Pregnant women who have been advised to self-isolate should stay at home and avoid contact with
others for 14 days. They should follow the same isolation recommendations as for the general
public. Advice is available on NSW Health website
Routine antenatal care and investigations should be avoided during this time – telehealth
interactions are encouraged
Review must be arranged if there is an urgent obstetric need (such as but not limited to APH, TPL,
PPROM, reduced FMF etc)
Unplanned presentations to the maternity unit – labour or acute
antenatal reviews approach to triage and care
Phone enquires: Screen all women who contact the maternity service by phone. Assess the clinical situation for
women with COVID-19 risk factors and determine if the woman requires immediate clinical
assessment and arrange review.
Verbal screening must be repeated and temperature check taken on arrival to the maternity unit.
COVID positive / suspected women should be asked to put on a surgical mask and moved to an
isolation room. All staff now required to adopt infection control measures appropriate to the clinical
exposure.
Post triage for risk of COVID-19 on arrival: If low risk for COVID-19 infection
• Utilise usual care pathways
• Avoid exposure to other known or potentially infected patients
If COVID-19 suspected or confirmed
• Utilise isolation and follow infection control protocols, ensuring correct use of PPE
• Where testing is indicated (as per https://www.health.nsw.gov.au/Infectious/covid-
19/Pages/case-definition.aspx) arrange swab - Rapid COVID swab available for women in
labour or at risk of labour in next 24 hours, refer to flow chart at end of document
• Transfer if the medical / obstetric condition allows to Port Macquarie Base Hospital if the
woman has presented to Kempsey District Hospital and has confirmed COVID-19 infection
• Manage as COVID – 19 suspected until swab results are negative or on advice of respiratory
team
Planned location of birth if COVID-19 positive • Women with confirmed COVID-19 infection are to birth at Port Macquarie Base Hospital if time
allows for a safe transfer.
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Intrapartum considerations (including induction of labour and
caesarean section) for COVID-19 positive / suspected women Refer to NSW Health website (https://www.health.nsw.gov.au/Infectious/covid-19/Pages/case-
definition.aspx) resources for the most up to date advice as to who is considered a suspected case of
or at risk of COVID-19 – this is constantly changing
There is limited evidence regarding COVID-19 and its risks of vertical transmission and risks in labour
– the risk is considered small but possible. We have taken a conservative safety first approach
regarding advice in the appendix
The following NSW Health Website provides useful information that should be reviewed in
conjunction to this document with regards to management Maternity and newborn care -
Communities of practice
Notifications: • The obstetric, paediatric & anaesthetic staff should all be notified and SCN alerted on
admission of a COVID positive / suspected woman.
PPE isolation and support people: Refer to CEC and MNCLHD COVID-19 Intranet for up to date information
• Single room, minimise face to face handovers, appropriate PPE
o All clinical staff and support person to wear appropriate PPE for the clinical
encounter
o Patient to be advised to wear a mask – but should not be forced to do so. She must
wear a mask when in transit and ideally when the door is open for staff entry / exit
• Follow MNCLHD advice regarding visitors
• Processes to allow for CTG 2nd checking and administration of drugs while minimising use of
PPE will be developed, flow charts at the end of this document
Labour: • If a swab result is not already available arrange a RAPID COVID swab
• Patients paper notes are considered ”dirty” and should not be brought out of the woman’s
room (until the patient leaves). A pack of all likely paperwork to be used for birth and
immediate post partum period will be brought into the room when the woman arrives
• FBC and IVC on admission to the Birthing Unit (risk of thrombocytopenia) – midwife collecting
the blood (donned) to label tubes and place them in a pathology bag, then the sample needs to
be double bagged with the request form in the second bag (the second bag should be held by a
“clean midwife” to minimise transmission)
• CEFM monitoring in labour
• Regular observations PLUS oxygen saturations
• Water birth and Water immersion are not recommended – as staff are not able to practice
appropriate PPE
• Individualised decision regarding shortening 2nd stage. Consider - woman’s preference,
maternal exhaustion, respiratory status, and infectious risk to those in the room.
• COVID-19 infection itself is not an indication for caesarean section – consider usual obstetric
indications plus assessment of respiratory status when making decisions.
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• Avoid Fetal Scalp Electrode and scalp blood sampling - potential risk of vertical transmission.
• Women should be made aware that the time required for staff to put on PPE may delay
decision to delivery time for instrumental birth or caesarean section
• Staff are NOT to enter the room / attend to the patient without appropriate PPE
• Midwife in the birthing room with a COVID positive/suspected woman should have constant
phone access with other staff
• Procedures will be developed to allow for CTGs to be reviewed, drugs and required equipment
to be delivered to the room – see pathway in Appendix 2
• Women who were considered low risk for COVID at the commencement of labour but who
develop respiratory symptoms or fever in labour should be reviewed by an Obstetric medical
officer and a Rapid COVID swab arranged and the woman managed as suspected COVID-19
positive until results are available (clinical judgement should be used where there is an obvious
obstetric indication for fever)
Third stage of labour: • Recommend active management of 3rd stage and avoid delayed cord clamping – to reduce risk
of PPH and may also reduce the risk of vertical transmission.
• The benefits of delayed cord clamping for preterm babies (before 32 weeks) may outweigh
risks however, paediatric advice should be sought regarding this decision.
Analgesia in labour: • Encourage early EDB for pain management (to reduce the need for general anaesthetic if an
urgent caesarean section was required). This decision will be made in discussion between the
woman, anaesthetic and medical staff considering the pros and cons and the projected
likelihood of operative delivery
• See pathway for consent and EDB in setting of COVID below in Appendix 2
• Nitrous Oxide: current advice in HMCN is to NOT to use Nitrous oxide for COVID positive /
suspected women. Use is acceptable in those women who are thought to be COVID negative
Care of the newborn immediately post birth: • Avoid placing the newborn directly on the mother’s abdomen as immediately post birth the
mother will NOT be considered to be practicing safe infection control and may expose the
newborn – wash the mother’s chest prior to skin to skin
• Regarding skin to skin ongoing contact – the known proven benefits of skin to skin contact
should be discussed together with an awareness of the small risk of transmission. Such contact
should only occur after the mother / support person have washed their hands and are wearing
face masks.
• Resuscitation of the newborn – is considered aerosol generating – all staff and support person
to wear PPE including P2 / N95 mask
Planned caesarean section if confirmed/suspected COVID-19 • Notify anaesthetics and theatres
• Book at end of list
• FBC & G+H (ensure FBC day of surgery)
• Paediatrician / registrar at birth – P2/N95 mask required
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• Patient should be made aware that the procedure will be slower than usual due to the
requirements for PPE – local agreement for HMCN that this will be P2/N95 masks for all staff
involved in a caesarean section – due to risk of conversion to GA mid procedure
• Follow advice in theatre
Anti-coagulation in COVID positive/suspected women • COVID-19 seems to be associated with a hypercoagulable state
• VTE risk assessment should occur for all women, COVID-19 infection will likely increase their
risk further
Changes to care Kempsey District Hospital for cases of confirmed /
suspected COVID-19 infection • Care will continue as normal at Kempsey District Hospital (KDH) unless a woman is
confirmed COVID-19 positive. Where this occurs they should be transferred to Port
Macquarie Base Hospital (PMBH) if safe to do so.
• Confirmed COVID -19 positive women during the antenatal period should be managed in
discussion with the respiratory team and the Obstetric consultant at PMBH
o Before 36 weeks likely ongoing care as described above via the GP Obstetricians at
KDH
o If beyond 36 weeks – ongoing antenatal and subsequent intrapartum care to be
managed via the ANC at PMBH (given that the woman will likely still be COVID-19
positive at the time of birth)
• Rapid COVID swab testing is available to speed up the diagnostic process
• Where women present to KDH with confirmed or suspected COVID-19 infection this
guideline should be used to aid management, PPE use etc. Once safe to transfer any woman
with confirmed COVID- 19 infection.
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Newborn Babies postnatal management of suspected/confirmed
COVID-19 • Refer all babies for formal review by the paediatric team, who should be notified of the
birth and asked to attend for the usual criteria
(COVID-19 along is not an indication for the paediatric team to be present for the birth)
• Routine SARS-CoV-2 testing of ASYMPTOMATIC newborn babies born to women with
suspected/confirmed COVID-19 IS NOT recommended;
• Testing IS indicated if the newborn infant becomes symptomatic within the minimum 14-
day incubation period, whether in the acute healthcare setting or at home
(combined oral / deep nasal swab – single swab kit to be used);
• Vertical transmission is considered possible, the proportion of newborns affected and
the significance to the newborn is unknown
• Wash all babies with soap and water after birth
• Give routine Hepatitis B vaccination and Vitamin K after bath
• Unless SCN admission is needed for neonatal clinical grounds the mother and infant
should be co-located and isolated together
• Babies are at risk of viral spread from a woman's respiratory secretions after birth. The
woman and support person who was present at birth should practice hand and respiratory
hygiene and wear a face mask during feeding or other close mother-baby interactions
including early skin to skin post birth, maintaining social distance of at least 1.5 metres
(cot >1.5 m from mother's bed)
• There is little evidence (but numbers of cases are limited) that the virus is carried in the
breastmilk, the main risk is close contact with the mother who is likely to share infective
droplets. Based on the current evidence breastfeeding may be encouraged with
appropriate support and education
• Women who are bottle feeding or expressing should adhere to strict sterilising
guidelines and have dedicated equipment during admission and follow hand hygiene
and PPE advice, consider non infected partner feeding baby (this may reduce but not
eliminate the risk of transmission to baby)
• Careful hygiene should continue until the woman has tested negative for SARS-CoV-2
and / or self isolation is not longer indicated based on current NSW Health advice
(currently 14 days after end of acute illness) – consult respiratory team
• Clinically well women and infants should be discharged home in the usual timeframe with
ongoing midwifery follow up in the home or a community setting – accelerated discharge
is not recommended
• Ensure ‘Blue Book’ check, SWISH hearing testing, & heel prick NBST are performed – these
are essential elements of care
• Consider providing ongoing breastfeeding and post natal support by telehealth where
available
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Appendix 1 – Port Macquarie Base Hospital Pathways
Flow chart 1 – Known COVID patient / suspected / contact in isolation who needs
clinic or outpatient review
If it’s decided they NEED a face to face visit
To access PMBH via RED ED or direct as advised by the HITH team who will be able to determine the
most appropriate location for review based on resources at the time and the patients clinical needs
Patient asked to put on surgical mask
Directed to birthing unit for review
To keep on surgical mask
Place patient in isolation room on birthing unit as available or alternate location as
advised by ED / HITH
Assessment completed
Staff droplet PPE precautions (unless labour)
If pathology or ultrasound required – bring the service to the woman
Admitted Discharged
To appropriate ward area Documentation complete
Follow up arranged
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Flow chart 2 – Antenatal care of COVID positive women or women in isolation due to contact
Once identified – careful review of antenatal record by CMC and VMO
Discuss care with the VMO during illness and after recovery
Determine if any routine / additional care is required during period of home isolation
Arrange what may be required – ensuring patient wears mask, care occurs in an isolation room at
hospital and bring care to patient (CTG, blood tests, ultrasound) as much as possible
Ensure phone call to patient each business day – hand over to on call registrar on weekend if
weekend calls are clinically indicated
Hospital in the home will be checking on woman’s general wellbeing daily also and can assist in
arranging face to face reviews if deemed clinically appropriate
Discuss care with Dr Chung / Dr Houghton regarding when patient will be able to stop isolating
Arrange face to face antenatal clinic appointment within a week of exiting isolation / recovery
in doctors clinic – ensure VMO has been notified
Arrange all outstanding antenatal care and arrange ultrasound 2 weeks after recovery (if was
confirmed COVID – ultrasound only needed on obstetric grounds if never diagnosed with COVID)
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Flow chart 3 – Woman COVID / suspected COVID / fever / respiratory symptoms
who presents for outpatient review
(non urgent obstetric concerns or non obstetric concerns)
Direct the woman to RED ED or as advised by the HITH team (who will be caring for COVID positive
women)
Consider if face to face obstetric visit is needed
To access PMBH via RED ED (or direct as above where appropriate)
Asked to put on surgical mask
Will be assessed in ED and if clinically indicated swabbed
Sent home if does not need obstetric review (ensure follow up)
OR
If obstetric review needed - directed to isolation room in birthing unit
(see flow charts 4 &5)
If admission indicated based on
COVID symptoms or non obstetric
reasons
Assessment completed
Staff droplet PPE precautions
If pathology or ultrasound required – bring the service to the woman
Admitted Discharged
(ensure obs review if has not already occurred)
To appropriate ward area Documentation complete
(may be ICU or BU or 2A or 3D) Follow up arranged
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Flow chart 4 – Women with COVID or suspected COVID who need review on BU with an urgent obstetric issue (including labour)
MW to meet woman in carpark (MW in appropriate PPE) or via RED ED if that is more appropriate
based on the clinical presentation
Woman asked to put on surgical mask
Arrange swabs if indicated (do not delay urgent obstetric care)
Placed in the assessment room in BU (if not laboring) or in Birthing room 1 if in labour
(see flow chart 6)
All staff to utilize appropriate PPE
Arrange appropriate medical and obstetric reviews
Assessment / management performed
If pathology or ultrasound required – bring the service to the woman (if possible)
Admitted Discharged
To appropriate ward area Documentation complete
(may be medical ward or ICU or BU or 2A) Follow up arranged
If in labour refer to labour pathway
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Flow chart 5: COVID-19 positive / suspected patient care in Birthing Suite – room set up
arrangements
Enters hospital via Red ED OR meet by MW (donned) in carpark - mask applied and directed to
Birthing Unit as clinically appropriate
Use of Birthing Consultation room with door closed
OR Birthing room 1 if in labour with door closed
Donning and Doffing of PPE outside room (clean area on right and dirty area on left)
Use a ‘Spotter’ Midwife when Doffing PPE to ensure correct technique of removal & discarding PPE
Barrier applied to dirty area to ensure contained within alcove
Minimal equipment kept in room (must including sharps container)
Observation equipment to be kept in room, designated battery operated CTG in room 1 at all times
Grab packs for cannulation, EDB, IDC, birthing kits, perineal repair, local, newborn vaccinations etc
Computer: WOW to be left in room if consultation room
COVID drug box in fridge
Weighing of the newborn – dedicated scales to be left in room 1
Support person: only 1 person (P2 mask) and unable to leave room until woman leaves room. Once
leaves room post birth, self -isolation as per NSW health. Meals provided for support person.
Supply information sheet to support person to explain this process
Mother – to wear mask where possible – but MUST be on if being transferred or door opened
Designated MW and Medical office as primary care providers during shift
CTG to be reviewed and counter signed by Medical Officer or midwife (if not in room – to bring CTG
machine to the open door (behind closed curtain) to allow for the CTG to be reviewed
Admitted Discharge
Woman transferred to ward wearing surgical mask Follow up as agreed with Doctor
And partner goes home Wear mask until in own car or arrive home
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Flow Chart 6 - Pathway for care of women and newborns via Home Midwifery Service in setting of
COVID-19
Women and all others who live in the home to be verbally screen prior to a visit and again at the
time of the visit for symptoms and risk factors for COVID-19
Screen negative Screen positive (visit to NOT occur at the
woman’s home)
Use telehealth consultation where possible
Ensure other home residents are Where face to face visit is needed
Screen negative D/W Paeds / O+G team as appropriate
If screen positive review options to include – ED, ward, GP
Visit as usual
Usual PPE precautions Schedule clinically appropriate time for review
Other family members in another part of AND determine most appropriate location
the house (social distancing) ensure appropriate staff available for review
Patient to access hospital via RED ED or direct (HITH
may be able to assist in arranging direct access)
Patient to put on surgical mask and patient directed
to allocated area for review in an isolation room
All staff to wear appropriate PPE
Admit to appropriate ward if required Discharged with follow up based on assessment
Mother and baby admitted together
where possible
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Pathway 7: EPAS referrals and management during COVID pandemic
Referral made by patients GP or ED or self referral as usual
Patients care triaged by EPAS Midwife and phone appointment made
Care may need to be coordinated via telephone visits until the COVID pandemic resolves
Return to face to face visits when considered reasonable based on community transmission and
social distancing advice from the DoH
If face to face visit is required arranged with on call registrar at a suitable time
COVID Negative women COVID positive / suspected women
Discuss care with on call VMO
See in EPAS and care usual / arranged Access via RED ED (HITH may assist in
arranging appropriate location for review)
Patient to wear surgical mask
Patient directed to suitable location for
review (may be Red ED, assessment room on
BU or other as per advice from ED or HITH) –
Patient not to be seen in EPAS room as too
difficult to perform terminal clean in this
room
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Rapid COVID swab testing procedures
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Appendix 2: Management of labour & post partum care for COVID
positive / suspected mothers and their babies – including anaesthetics
– this advice is relevant for PMBH and KDH (where transfer is not
possible or awaiting Rapid COVID swab result) If suspected COVID – 19 arrange RAPID COVID SWAB
Single room and notifications
• Refer to advice from MNCLHD regarding visitors / support person
• Notify – SCN, paediatrics, obstetrics and anaesthetics
• Ensure M/W in the birthing room has constant telephone contact with other staff members
Support people
• 1 support person only – must not have COVID or symptoms (fever or respiratory symptoms),
2nd support person only on compassionate grounds
• Must stay in the room with the birthing woman at all times and leaves the hospital once
birthed, must wear P2/N95 mask at all times
• Must be advised to self isolate for 14 days post (as is now a close contact) post birth
PPE
• Patient to wear mask (guidance as per MNCLHD)
• Support person (as per MNCHLD advice) should also wear a N95/P2 mask
• Staff should wear N95/P2 masks (as agreed with Executive HMCN)
• Staff safety is NOT to be compromised, use of appropriate PPE is mandatory Labour care
• FBC, IVC
• Continuous CTG in labour
• NO water birth
• LSCS for obstetric reasons
• Avoid FSE and FBS
• Encourage EDB
• NO nitrous use (local decision agreed with Executive HMCN)
• Active Mx of 3rd stage
• No delayed cord clamping (consider before 32 weeks) – local decision with Paediatricians
• All staff to wear P2/N95 masks during labour, caesarean section and resuscitation / CPAP of the newborn
Post natal care for newborn
• Do not place baby directly on maternal abdomen – wash mothers chest prior to skin to skin
• Notify Paediatrican of labouring woman, presence for birth as per usual calling criteria
• Wash baby immediately after birth prior
• Usual vaccinations (vit K and hep B) post baby bath
• Advice regarding required PPE – refer to Paediatricans / MNCLHD advice
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Procedure for Epidural in a COVID positive/suspected patient
At the time of the call for epidural ensure patient has:
● IV access ● recent FBC, GH ● epidural information sheet/consent form given
○ to reduce time in delivery suite room consider going through the epidural information over the phone with the patient
○ eg ask midwife to instruct patient to call anaesthetist on anaesthetic phone once information sheet read
Before entering the room:
● check platelets (thrombocytopenia common with COVID19) (coags only if indicated) ● anaesthetist +/- 2nd midwife to prepare all equipment and place on a separate
trolley, please refer to EDB equipment checklist ● clean EDB trolley and documentation to be left outside the room ● patient must wear surgical mask AT ALL TIMES
Go to donning area/prep trolley:
● don N95/P2 mask, head cover, eye protection ● sterile wash ● sterile gown, gloves -2 pairs
Enter the room:
● Midwife ○ open the door for anaesthetist ○ take trolley with equipment and epidural pump into the room ○ position the patient ○ ensure fluids running ○ open the packs onto the trolley
● Anaesthetist ○ perform anaesthetic assessment including airway exam ○ obtain informed consent
■ confirm patient read and understands the procedure, associated risks ■ offer to answer questions if any ■ patient signs consent on epidural information sheet
○ insert epidural ○ doff 2nd pair of gloves ○ connect the epidural to the pump ○ ensure epidural is effective ○ dispose sharps, leave the trolley in the room
After leaving the room:
● doff PPE ● wash hands ● complete clean documentation ● refer to written consent when completing epidural paperwork
Developed in consultation between Anaesthetic and O&G Departments at PMBH
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EDB equipment checklist
100mcg fentanyl
20ml 0.2% ropivacaine
2 x 5ml 1% lignocaine
4 x 10ml sterile saline plastic vials
Epidural Pack with Fenestrated sterile drape and dressing pack
Non-fenestrated sterile drape for work
20ml syringe
5ml syringe
3ml syringe
1 x sharp 22G blue needle
2 x 20G drawing up needles
1 x red filter needle
18G Tuohy epidural kit
Chlorhexidine alcohol skin prep.
Large Tegaderm
Hypafix (4 short and 1 long piece)
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Any additional equipment specific to your practice
Epidural pump
0.1% Ropivacaine/fentanyl 200ml bag
Yellow epidural tubing
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Anaesthesia For Cat 1 Caesarean Section
For COVID-19 positive/ suspected patients
EPIDURAL IN SITU?
YES NO
CONSIDER THE CLINICAL
AND THEATRE SITUATION
TO CHOOSE EITHER..
WORKING WELL?
YES NO / NOT SURE
EPIDURAL TOP UP RAPID SPINAL GA
* all don aerosol PPE
Anaes 1- don aerosol PPE,
epidural top up ASAP wherever
patient is, maternal assessment,
transfer of patient to OT
Anaes 2 prepare OT, drugs
Anaes nurse - prepare OT
Anaes Runner - – get COVID
PPH box 1
Left tilt
* all don aerosol PPE
Senior anaes - prepare spinal
Anaes nurse prepare spinal
Anaes 2 - maternal assessment,
IV access confirmation,
preparation, support,
positioning, monitoring, drugs
Anaes runner – get COVID PPH
box 1
Left tilt
* all don aerosol PPE
Proceed as per COVID
intubation checklist and
COVID intubation/extubation
procedure
expect desaturation
Anaes runner – get COVID
PPH box 1
Left tilt
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References NSW Health COVID-19 Maternity NICU SCN. Maternity and Neonatal care. Version 3, Communities of Practice - https://www.health.nsw.gov.au/Infectious/covid-19/communities-of-practice/Pages/maternity-and-newborn-care.aspx Queensland Health, Clinical Excellence Queensland. COVID-19 Guidance for Maternity Services. State-wide Maternity and Neonatal Clinical Network. Updated 29th April 2020 - https://www.health.qld.gov.au/__data/assets/pdf_file/0033/947148/g-covid-19.pdf RCOG – Coronavirus (COVID-19) Infection in Pregnancy. Information for Healthcare Professionals Version 10 - https://www.rcog.org.uk/globalassets/documents/guidelines/2020-06-04-coronavirus-covid-19-infection-in-pregnancy.pdf RANZCOG Coronavirus (COVID-19) information as available at production of this report - https://ranzcog.edu.au/statements-guidelines/covid-19-statement L Poon et al. ISUOG Interim Guidance on the novel coronavirus infection during pregnancy and puerperium information for health professionals. Ultrasound in Obstetrics and Gynaecology. 11th March 2020. https://doi/org/10.1002/uog.22013