Joint Statement on Patient Centered Pregnancy Care during COVID
ACOG Practice Advisory on COVID-19 and ACOG COVID+ preparedness module (including cases)
CDC practice guidance for pregnant patients
CMS webinar regarding care of patients in obstetrical units (registration is free) and Anne Drolet, MD's excellent notes
DFMCH presentation on OB care during COVID by Ally Couture, DO from 4/30/20
Meriter's guide on care of OB patients from 3/23/20
Meriter Newborn Nursery Action plan from 4/8/20
Society for Maternal Fetal Medicine Guidance on inpatient care
UNC Community Campus Partnerships for Health presentation on Birth Equity during COVID-19
Please see the newborn care tab for additional information regarding breastfeeding and mother-infant separation policies
Univeristy of California San Fransisco PRIORITY registry for COVID+ pregnant patients
From the AAP section on Neonatal Perinatal Medicine (website/info here) -- Registry Link
Where to get PPE: The 2N Monona Conference Room (in the North wing across from OB Triage) is the 24/7 PPE Hub for providers and staff. This includes surgical masks, face shields, and N95s. Quick guide for PPE from 4/10/20
Regarding N95 masks at Meriter: Meriter has the same N95 masks as UW since their supply chain is integrated, you do not need a new FIT test for Meriter if you have been tested through UW.
How to remove N95 mask for storage without self contamination: https://vimeo.com/407330155/c0bdf9f0ec
Meriter's policy on N95s in the second stage of labor (from 4/24/20 email):
According to the CDC, forceful exhalation during the second stage of labor would not be expected to generate aerosols to the same extent as procedures more commonly considered to be aerosol generating (such as bronchoscopy, intubation, and open suctioning). During mask shortages CDC recommends preserving respirators such as N95s for procedures most likely to generate higher concentrations of infectious respiratory aerosols.
We consider ourselves to be in a conservation phase of respirators such as N95s and we recognize the concerns from the OB teams. While we do not think there is valid evidence at this time to support the use of N95s in patient labor, OB providers and nurses may choose to use an N95 for an unknown or COVID positive status patient during their 2nd stage of labor until delivery of the baby. In the event that a COVID surge occurs, impacting our supply needs, we may need to re-evaluate this decision.
N95 respirator use in these cases is not recommended when caring for patients with no symptoms to suggest COVID-19 disease who have screened negative for COVID-19 including during the second stage of labor. Inappropriate use of N95 respirators creates unnecessary depletion of supply, increased risk of infection to the person wearing the mask due to discomfort leading to more frequent adjustments and contamination, as well as possible cross-contamination when worn between patients.
All labor patients will now be getting screened for COVID 19 (see link for details). For patients who have been screened >24 hours previously with new symptoms (fever and respiratory complaints) would merit COVID re-testing regardless of the confounding clinical scenarios. i.e chorioamnionitis, flu etc.
Please see AJOG and NEJM statements on universal testing for obstetrical patients
Visitor information patient handout for L&D/pp/newborn and "Beginning of Life" visitor process
Tubal sterilizations can be done at Meriter as of 4/24/20
Waterbirths have been restarted as of 5/11/20
Information regarding elective induction cancellation (email 3/19)
Please relay the following information to the patient when discussing or scheduling an elective induction:
Every effort will be made by L&D to bring you in for your elective induction.
Due to the potential effects of COVID-19 on the workforce and patients, your elective induction may need to be cancelled.
The Labor and Delivery charge nurse will call you and your OB or on call OB provider.
You will be asked to call the clinic and follow up with your OB provider to address rescheduling the induction, discuss prenatal care needs and develop a new delivery plan.
Meriter COVID Hub (use Epic username/password to enter)
Daily call in minutes for Meriter (use Epic username/password to enter)
As of 4/28/20 DFMCH faculty have resumed care of all of our patients at St Mary's
Screening at SSM: Use the SSM Health employee screening app (access the self-screening website on your smart phone at employeescreening.ssmhealth.com and watch this video for a detailed demonstration, save this to your home screen to save time). A camera is stationed outside the main doors to the tunnel; when you arrive, show your green check to the camera, verifying you are able to enter the building. Security will be monitoring the camera and once verified, will open the doors to allow you to enter. (For staff who do not have access to a cell phone or thermometer, a thermometer and an iPad for staff to access the employee screening app will available at the door. Please make sure to wipe down both the thermometer and iPad after each use.)
Where to get PPE: You will be able to pick up your masks when you pass through screening upon entering the hospital (you no longer need punch cards). Please see the charge nurse for your face shield and N 95 or P100 mask if needed
Regarding N95 masks: Your UW fit testing is "good" at St Mary's - please refer to Jenny White (for residents) or your site leads (attendings) for info on sizes/re-fit testing.
How to remove N95 mask for storage without self contamination: https://vimeo.com/407330155/c0bdf9f0ec
Email update from Jen Krupp (from 4/4/20)
Pain management info (4/3/20) -- please note NO not being offered! Note the dot phrase .covidpainmgtlaboring which contains info on options/recommendations
Visitor information specific for 2 south
SMH info on mag, bmz, etc (from 4/3/20)
SMH Newborn Care recommendation for providers and for patients (for newborns of COVID+ mothers recommend a bath asap and select "least risk" vs "reduced risk" strategy, newborns will also be tested at 24 hrs and again at 2-5 days). See algorithm here
At this time newborns of COVID+ patients will not be able to have circumcision in the hospital - We will provide updates if this changes
St Mary's MFM is not currently recommending enhanced screening for pregnant patients who are COVID+, including recommendation for induction at 39 weeks.
.dcinstructionscovid (should be used for all patients being discharged from postpartum/newborn)
.dcinstructionsbpcuff (for patients with elevated blood pressures at discharge)