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.