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.