4. Protective measures during vaginal delivery of pregnant women with confirmed or suspected COVID-19
The SARS-CoV-2 is mostly transmitted through respiratory tract and exposed to infection. In a recent retrospective clinical study, it has been pointed out that the hospital related transmission of COVID-19 is not uncommon 14 . Therefore, environmental management and personal protection should be carried out in the vaginal delivery of pregnant women with confirmed or suspected COVID-19.
If the department of obstetrics already has a negative pressure isolation delivery room, pregnant women with confirmed or suspected COVID-19 should, in principle, complete vaginal delivery in the negative pressure isolation delivery room. If the conditions are limited, there is no negative pressure isolation delivery room, the delivery can also be completed in a single isolated delivery room. The isolation delivery room should be provided with three areas and three passages, the three areas refer to clean areas, semi-polluted areas, and polluted areas, the three passages refer to medical personnel passages, maternal transport-only passages, and dirt passages. The central air conditioning circulation system should be closed, use plastic sheeting to close each vent, and use electric heating equipment to maintain the indoor temperature if necessary. The delivery room should be simplified with only necessary facilities such as delivery bed and neonatal radiation table. The delivery room should be simplified with only necessary facilities such as delivery bed and neonatal radiation table. In case of limited conditions or emergency situations, vaginal delivery can be carried out in isolation ward under strict protection.
In the process of delivery, the number of attendants should be as few as possible, and the number of medical staff required for treatment should be reduced to a minimum in the isolation delivery room (or isolation ward). Only one senior midwife and one first-line obstetrician stay in the isolation delivery room, with two-level protection, if conditions permit, three-level protection can be provided, i.e. wearing positive pressure headgear or full-breathing protector, and the midwife can wear disposable waterproof overshoes. The second-line obstetrician and pediatrician can take two-level protective measures and stand by outside the isolation delivery room (or isolation ward) to prepare for the emergency situation of pregnant women and newborns.
Placental tissue is disposed according to the principle of infectious biological waste disposal. It is packed in double-layer yellow medical garbage bags in the isolation delivery room (or the isolation ward), the two-layer garbage bags are sealed in layers to ensure tight sealing, and marked with “COVID-19” and “placenta”, after the surface was sprayed with 1000mg/L chlorine-containing disinfectant. Reusable medical equipment can be reused in a special instrument box, after 30 minutes of immersion in 2000mg/L chlorine-containing disinfectant, sealed in layers with a double-layer yellow medical garbage bag, and marked with “COVID-19”, collected and cleaned by a special person, then complete the subsequent sterilization. If the delivery is completed in an isolated delivery room, the indoor air is continuously fumigated and sterilized using a vaporized hydrogen peroxide machine in the closed state for 2 hours; if the delivery is completed in an isolated ward, the indoor air is disinfected by a human-machine coexisting air disinfection machine for 4 hours. The indoor floor should be cleaned with 2000mg/L chlorine-containing disinfectant, and the fixed facilities in the isolation delivery room (or the isolation ward) should be wiped with 1000mg/L chlorine-containing disinfectant. The surface that was in contact with the patient’s body fluids, blood and other contaminated surfaces shall be treated with 2000mg/L - 5000mg/L chlorine-containing disinfectant. Indoor precision medical supplies, such as ECG monitors, stethoscopes, fetal heart monitors, infusion pumps, etc. can be thoroughly wiped and disinfected with 75% ethanol solution or 1000mg/L chlorine-containing disinfectant.