2. Management of pregnant women with confirmed or suspected COVID-19 during vaginal delivery and the pregnancy outcomes.
During the course of labor, due to the intolerability of the labor pains, the cooperation degree of the pregnant women is reduced, they may cry, cough, hyperventilate and so on, thus, a large number of droplets and aerosols are generated, which increases the exposure and infection possibility of the medical staff. Thus we should strengthen the humanistic care for pregnant women, actively give them guidance, comfort and encouragement in the process of delivery, effectively communicate with pregnant women, stabilize the mood of pregnant women, and help them to eliminate their fear. Pregnant women with confirmed or suspected COVID-19 were given nasal catheter oxygen inhalation immediately after entering the isolation delivery room (or isolation ward), and wore medical surgical masks11 . Provide energy support, free position can be used to promote vaginal delivery and try to alleviate the pain and discomfort of pregnant women. Continuous ECG monitoring if necessary. In order to avoid too long labor process caused excessive physical consumption of pregnant women and increase the burden of cardiopulmonary function, on the premise of ensuring the safety of the mother and fetus, the labor process should be shortened as much as possible to reduce the exposure time of the fetus in the obstetric canal. If necessary, episiotomy, forceps operation and vacuum extraction can be used as midwifery. Timely compress and hemostasis the perineal wound to reduce the contact between fetus and mother blood. In the process of delivery, pay attention to avoid the pollution caused by amniotic fluid and blood splashing, absorbent mattress mats can be laid on the floor around the delivery bed, and disposable sterile liquid storage bag can be placed under the buttocks of pregnant women to collect amniotic fluid and blood. After delivery of the fetus, oxytocin should be used as early as possible to promote uterine contraction, if necessary, ergometrine and/or long-acting oxytocin should be used in time to promote uterine contraction. Take other necessary measures to actively prevent postpartum hemorrhage according to the situation. After the delivery of fetus and placenta, routinely check the soft birth canal and suture the perineal incision wound or perineal laceration in time. Observed in the isolation room for 2 hours after delivery, or in the isolation ward under the supervision of the midwife for 2 hours. Strictly monitor vital signs, observe uterine contractions and vaginal bleeding, meanwhile, provide postnatal care for parturient women.
In this retrospective study, 10 pregnant women in the isolation ward of Obstetrics had no significant abnormality in the continuous monitoring of vital signs and blood oxygen saturation during the labor process, and the labor process was smooth. The second labor process was 10 minutes to 1 hour, no forceps and fetal head suction attendant midwifery. Only 3 cases of these primiparas underwent perineal resection to shorten the labor process and avoid severe perineal lacerations considering the possibility of fetal overgrowth. There was no significant difference in the amount of postpartum hemorrhage between the pregnant women with confirmed or suspected COVID-19 and the pregnant women without COVID-19. During the postpartum observation, no exacerbation of respiratory symptoms was observed in all cases. However, one patient considered acute fatty liver during pregnancy after the emergency vaginal delivery, and the lung CT showed the progression of viral pneumonia, which improved after the treatment in ICU. Therefore, it is necessary to strengthen the monitoring of such patients after delivery, just as important, the infectious diseases indicators and lung CT should be rechecked in time. At sometimes, it is necessary to carry out multidisciplinary consultation and cooperation including respiratory department, infection department and ICU to ensure perinatal safety.