ACOG SMI & NYSDOH NYSPQC Webinar: Managing COVID-19+ Pregnant Patients - Shared screen with speaker view
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Our song is "don't stop believing" by Journey
what is creteria for testing or in the PP period if they have low grade fever? are we still waiting for 100.4F to get pt tested? or should threshold be lower for testing?
We use 100.0
we test all of our patients on admission
Follow-up question for Dr. Bernstein: Is it recommended to give pregnant patients with COVID-19 treatments for their infection? What data do we have on the impact on fetuses of these treatments?
Are you doing pulse-ox assessment in outpatient setting?
how low would you go before supplementing with O2
We supplement for O2 sat <95%, if requiring O2 we manage as inpatient while pregnant.
Some concern about use of ASA81 (renal effects). Please comment about stopping ASA81 in patients Sx for COVID? Asymptomatic positives?
I missed some of Dr Bernstein's comments.
Did her say there is outpatient or inpatient treatment specifically for COVID?
Hi, Gaetane. The webinar is being recorded if you’d like to go back and review Dr. Bernstein’s comments.
We are continuing the low dose ASA along as renal function is okay
Dr. Bernstein's comments won't be clear on recording either, it "blanked out"
What are your thoughts on the use of IL-6 inhibitors for pregnant patients who are positive?
What has everyone done when universal testing is not available?
Do any one know if the saliva COVID test is as sensitive as the Nasopharyngeal swab testing?
Where are Dr. Wilcox and Dr. Goffman from? Doing universal testing.
We are doing universal testing across the NYP system
What precautions are you taking for patients who test negative given there is evidence including recent data from Columbia that patients may become positive during the admission even if they were negative and symptom free .
What is the policy visitation in the NICU?
Follow-up prenatal care - How are you making the other patients coming to the office feel "safe" in the outpatient office?
Hi Gina, Dr. Wilcox is at HHC Kings and Dr. Goffman is from NYP.
All patients, support individuals and providers masked. We reswab if a negative patient develops symptoms during admission.
All patients delivering in the hospitals that are part of Mount Sinai Healthcare System are tested for COVID.
I am from NYC Health + Hospitals/Kings County but all H+H system hospitals are moving toward universal testing.
at Woodhull we have also been doing universal testing for a couple of weeks. so far 25% positive majority asymptomatic
Is anyone aware of any newborns infected either at delivery or through respiratory droplet transmission after delivery?
We test everyone
No. All newborns for COVID+ moms were tested negative at around 24 hrs of life.
so far all newborns tested neg for those mothers
From Lisa Clark to Me: (Privately) 03:22 PMThere seam to be intuitional differences for care of newborn discharge to home, Precauations
From Lisa Clark to Me: (Privately) 03:26 PMyes I don't know what I am doing. Some say to isolate mother for 14 days, others isolate newborn for 7 days and at least 3 days fever free
do you use N-95 as well as universal testing?
what is the latest recommendation regarding use of oxygen for intrauterine resuscitation?
We have stopped using oxygen for intrauterine resuscitation of fetal tracings. Oxygen supplementation should still be used for patients who require it for oxygenation
We use N95 and full PPE for every delivery, vaginal and C/section even with universal testing. We also test the support person for laboring patient and for c/section.
We have also stopped using (O2 for intrauterine resuscitation
If doing universal testing of patients admitted to ob - are you also doing universal testing of staff working in ob? Thanks, Jackie Ford
No, no testing for the staff.
No testing for staff
Not testing staff. But the staff is wearing PPE—to protect themselves and others
There seam to be intuitional differences for care of newborn discharge to home, Precauations for covid + mothers. Some say to isolate mother for 14 days with no contact of newborns and others isolate newborn for 7 days and at least 3 days fever free allowing 30 min contact for feeding only must wear a mask.
Not testing staff-similar to others they are protecting themselves with PPE
At what point after delivery do they stop wearing the full PPE?
Our staff has the ability to be tested. They just need to make an appointment
Will this presentation be available later?
Staff stop using PPE post delivery when pt has met criteria for transfer to mother-baby
The full PPE comes off for COVID- patients in recovery period/PACU for c/section.
2 hours at our institution.
most staff at my institution wear n95s at other times that just the 2nd stage and c/s, and cover it with another mask. the n95s may be changed in a set period of time of use.
A recording of this webinar will be made available following the event. We will e-mail a link to all registrants and participants.
PUI pts need N95 use aswell.
How many times are you reusing your N95s - UV radiation or Bioquel
Received via email: We are testing all mothers upon admission to labor and delivery. If a mother has tested negative as an outpatient, do you repeat testing upon admit and if so, after how many days?
For discharged COVID positive patients that have babies in the NICU, where are you screening the mom for the 2 negative COVID tests required for NICU visitation?
We use our N95 until it is broken or visibly soiled. Recently we have bene given th option to get a new one if you want. But we are encouraged to reuse until broken, damaged, or visibly soiled.
Do you ever use N95s for more than one shift
we can use n95s up to 5 days or changed earlier if soiled, broken
We use N95 for max of 3 days unless soiled, broken, etc. N95s get UV'd at the end of the shift
HI Camie, because the outpatient testing is a different test at a different laboratory, the mother would be tested again upon admission. Because of the high false negative rate, the rapid test which is the test performed on admission may actually offer a different result.
is there evidence of antibodies in breast milk
Is there any evidence that N95 is superior to surgical mask regarding transmission of COVID to providers? Most of the "evidence" seems to be based upon intuition.
I would urge caution creating the expectation that mothers may be routinely discharged at 24 hrs; while that may be fine for the mother it is only safe for newborns in low risk scenarios and even then it puts additional burden on outpatient pediatric care and may result in additional outpatient visits for the newborn (for example to follow up jaundice or poor feeding), hence additional exposures to the doctor’s office. So there is a big tradeoff here that needs to be considered.
Received via email: I missed what was said specifically about medication given to symptomatic individuals with PUI and/or Covid +. Are any physicians giving azithromycin to everyone and/or Plaquinel?
according to cdc, the has not been evidence of antibodies in breastmilk...to date
Now that the peak has been reached in NY will our mothers be allowed to stay past 24hrs to receive the care they need.
Patients are being discharged when medically and socially ready. Differs for vaginal delivery and cesarean
From rebecca shiffman to Me: (Privately) 03:48 PMwe're discharging after 25 hours if pediatricians have cleared the baby
we have done 24 hours postpartum or 48 hours post c/s if patients are medically stable for d/c.
From I ffath Hoskins:are there any additional concerns for the Covid positive its during the days/weeks after discharge? Eg should these pts have additional contact?
We are following patients closely with telehealth visits after discharge.
NYS testing for NB begins at the 25 th hour of life. once completed could be eligible if feeding well which is not in every case, (if breast feeding at least 2 good feeds) Must have F/U in 48 hrs
Is everyone allowing support person in the delivery
Can you address the use of beta-methasone after 34 weeks in a low incidence setting 4/14/20 SMFM statement states practices could consider adjusting protocols , balancing risk vs benefits
Yes to the one support person. As long as the support person is not symptomatic, the support person is allowed in an LDR. Not in the OR
we have been allowing one visitor. that person must stay with the mom the whole time so not going back and forth and stay postpartum for up to 8 pm then must leave
One support person goes along with NYS DOH guidelines for L&D
This is what's being reported nationally in terms of F/U for these babies going home. It's actually impacting both the infant born to a covid+ mother and healthy mothers. Peds is using telehealth visits to support the early NB care and help determine which babies really need to come for an in-person visit.
Agree with CC's comment. Also support person given a mask
Here as Flushing medicial we also been using the main OR for all schedule Cesarean delivery to keep the work flow going.
yes. visitor does have mask and screened with symptoms prior to entry
We have been told not to wear a mask over an N95 as it might dislodge or be askew. We are given an n95 for a week. What is your thought on that?
At what intervals if any are prenatal patients brought into an outpatient setting for evaluation as opposed to telehealth prenatal visits?
Most centers are using a procedure/surgical mask over their N95 when this resource is limited.
We are allowing one support person in L&D for both patients in labor and scheduled c/sections. Every support person is screened and tested either upon arrival to L&D and, in case of scheduled deliveries, in pre-admission testing at the time the patient gets swabbed
Understand the Aerosol Generating Procedure comments from Dr. Bernstein but is there evidence that a patient who is wearing a mask or behind a barrier during second stage is actually generating aerosols? CDC did not make that statement.
can you speak to your experience with resdivir if any?
Where (on unit or lobby) are hospitals discharging the newborn of a COVID mother? When discharging the newborn, must be to a asymptomatic family member- are we allowing this family member on the unit?
We do rolling discharge for vaginal at 36 hours and 48 hours for c/s
where do mother obtaining the 2 negative tests after discharge?
Montefiore has the same NICU visitation policy as NYP
I can comment on a neonatologist survey Ed LaGamma
How many days apart are you reswabbing COVID+ NICU moms?
for Covid + mothers with NICU babies, do you provide tests in the hospital?
2 swabs at least 24 hrs apart if swab based approach
DOH is not willing to test those with no symptoms.
we are trying to figure out how to swab mothers
when they leave the hospital
Thank you for those final words of inspiration.
Discontinuation of transmission-based precautions for patients with COVID-19Non-test-based strategy.• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,• At least 7 days have passed since symptoms first appearedPersons with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue isolation• When at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness provided they remain asymptomatic;• For 3 days following discontinuation of isolation, these persons should continue to limit contact (stay 6 feet away from others), and;• Limit potential of dispersal of respiratory secretions by wearing a covering for their nose and mouth whenever they are in settings where other persons are present. In community settings, this covering may be a barrier mask, such as a