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ACOG SMI & NYSDOH NYSPQC Webinar: Managing COVID-19+ Pregnant Patients - Shared screen with speaker view
Peter Bernstein
23:01
I am here but can’t unmute myself
Peter Bernstein
23:19
I am muted by the host.
Tina Wells
30:56
Our song is "don't stop believing" by Journey
wafa yousef
38:29
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?
Dena Goffman
39:28
We use 100.0
Trisha Marcel
39:55
we test all of our patients on admission
Kristen Lawless
41:36
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?
Vanessa Barnabei
42:54
Are you doing pulse-ox assessment in outpatient setting?
Ariane Ivala-Walker
43:23
how low would you go before supplementing with O2
Dena Goffman
44:44
We supplement for O2 sat <95%, if requiring O2 we manage as inpatient while pregnant.
Mark Rosing
45:09
Some concern about use of ASA81 (renal effects). Please comment about stopping ASA81 in patients Sx for COVID? Asymptomatic positives?
Gaetane Francis
45:16
I missed some of Dr Bernstein's comments.
Gaetane Francis
45:35
Did her say there is outpatient or inpatient treatment specifically for COVID?
Kristen Lawless
45:36
Hi, Gaetane. The webinar is being recorded if you’d like to go back and review Dr. Bernstein’s comments.
Peter Bernstein
45:39
We are continuing the low dose ASA along as renal function is okay
Anita Adler
46:01
Dr. Bernstein's comments won't be clear on recording either, it "blanked out"
Nicole Geiger
46:23
What are your thoughts on the use of IL-6 inhibitors for pregnant patients who are positive?
CAMILLE CLARE
47:10
What has everyone done when universal testing is not available?
maria smilios
47:16
Do any one know if the saliva COVID test is as sensitive as the Nasopharyngeal swab testing?
Gina Paquette
50:36
Where are Dr. Wilcox and Dr. Goffman from? Doing universal testing.
Dena Goffman
50:57
We are doing universal testing across the NYP system
Gaetane Francis
50:58
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 .
Karen Lockworth
51:13
What is the policy visitation in the NICU?
David Garry
51:15
Follow-up prenatal care - How are you making the other patients coming to the office feel "safe" in the outpatient office?
Kristin DeVries
51:38
Hi Gina, Dr. Wilcox is at HHC Kings and Dr. Goffman is from NYP.
Dena Goffman
52:01
All patients, support individuals and providers masked. We reswab if a negative patient develops symptoms during admission.
Elena Lobatch
52:29
All patients delivering in the hospitals that are part of Mount Sinai Healthcare System are tested for COVID.
Wendy Wilcox
53:18
I am from NYC Health + Hospitals/Kings County but all H+H system hospitals are moving toward universal testing.
Paul Kastell
53:54
at Woodhull we have also been doing universal testing for a couple of weeks. so far 25% positive majority asymptomatic
Mona Bonanno
54:00
Is anyone aware of any newborns infected either at delivery or through respiratory droplet transmission after delivery?
Mary O’Brien
54:22
We test everyone
Elena Lobatch
54:52
No. All newborns for COVID+ moms were tested negative at around 24 hrs of life.
Mona Bonanno
55:30
Thank you
wafa yousef
55:35
so far all newborns tested neg for those mothers
Corey Greene
56:30
From Lisa Clark to Me: (Privately) 03:22 PMThere seam to be intuitional differences for care of newborn discharge to home, Precauations
Corey Greene
56:36
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
whitney hall
56:59
do you use N-95 as well as universal testing?
Anne Shea-Lewis
57:06
what is the latest recommendation regarding use of oxygen for intrauterine resuscitation?
Dena Goffman
58:00
We have stopped using oxygen for intrauterine resuscitation of fetal tracings. Oxygen supplementation should still be used for patients who require it for oxygenation
Elena Lobatch
58:50
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.
Neila Hernandez
58:58
We have also stopped using (O2 for intrauterine resuscitation
Jacqueline Ford
59:37
If doing universal testing of patients admitted to ob - are you also doing universal testing of staff working in ob? Thanks, Jackie Ford
Elena Lobatch
01:00:07
No, no testing for the staff.
Neila Hernandez
01:00:21
No testing for staff
Peter Bernstein
01:00:37
Not testing staff. But the staff is wearing PPE—to protect themselves and others
Lisa Clark
01:00:53
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.
Dena Goffman
01:00:54
Not testing staff-similar to others they are protecting themselves with PPE
Deanna Shon
01:00:57
At what point after delivery do they stop wearing the full PPE?
Wendy Wilcox
01:01:23
Our staff has the ability to be tested. They just need to make an appointment
Sharon Quayle
01:01:32
Will this presentation be available later?
Neila Hernandez
01:01:39
Staff stop using PPE post delivery when pt has met criteria for transfer to mother-baby
Elena Lobatch
01:02:11
The full PPE comes off for COVID- patients in recovery period/PACU for c/section.
whitney hall
01:02:12
2 hours at our institution.
CAMILLE CLARE
01:02:28
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.
Kristen Lawless
01:04:04
A recording of this webinar will be made available following the event. We will e-mail a link to all registrants and participants.
narda martin
01:04:33
PUI pts need N95 use aswell.
Craig Zelig
01:06:48
How many times are you reusing your N95s - UV radiation or Bioquel
Camie Berardi
01:08:11
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?
Garfield Clunie
01:08:26
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?
Nicole Geiger
01:08:48
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.
Craig Zelig
01:09:30
Do you ever use N95s for more than one shift
CAMILLE CLARE
01:09:33
we can use n95s up to 5 days or changed earlier if soiled, broken
Neila Hernandez
01:10:28
We use N95 for max of 3 days unless soiled, broken, etc. N95s get UV'd at the end of the shift
Wendy Wilcox
01:10:36
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.
Theresa Spross
01:11:19
is there evidence of antibodies in breast milk
Craig Zelig
01:12:36
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.
Jonathan Chai
01:13:31
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.
Camie Berardi
01:13:40
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?
Wendy Wilcox
01:13:56
according to cdc, the has not been evidence of antibodies in breastmilk...to date
narda martin
01:16:15
Now that the peak has been reached in NY will our mothers be allowed to stay past 24hrs to receive the care they need.
Dena Goffman
01:17:38
Patients are being discharged when medically and socially ready. Differs for vaginal delivery and cesarean
Corey Greene
01:18:09
From rebecca shiffman to Me: (Privately) 03:48 PMwe're discharging after 25 hours if pediatricians have cleared the baby
CAMILLE CLARE
01:18:25
we have done 24 hours postpartum or 48 hours post c/s if patients are medically stable for d/c.
Corey Greene
01:20:18
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?
Dena Goffman
01:20:57
We are following patients closely with telehealth visits after discharge.
Lisa Clark
01:21:33
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
Craig Zelig
01:21:53
Is everyone allowing support person in the delivery
Kathleen Dermady
01:21:56
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
Wendy Wilcox
01:22:36
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
CAMILLE CLARE
01:22:55
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
Wendy Wilcox
01:23:06
One support person goes along with NYS DOH guidelines for L&D
Deborah Campbell
01:23:32
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.
Wendy Wilcox
01:23:38
Agree with CC's comment. Also support person given a mask
Ivan Ngai
01:24:10
Here as Flushing medicial we also been using the main OR for all schedule Cesarean delivery to keep the work flow going.
CAMILLE CLARE
01:24:17
yes. visitor does have mask and screened with symptoms prior to entry
jane weckesser
01:24:19
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?
robyn mckeefrey
01:24:54
At what intervals if any are prenatal patients brought into an outpatient setting for evaluation as opposed to telehealth prenatal visits?
Deborah Campbell
01:25:31
Most centers are using a procedure/surgical mask over their N95 when this resource is limited.
Elena Lobatch
01:25:35
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
Craig Zelig
01:25:48
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.
CAMILLE CLARE
01:25:57
can you speak to your experience with resdivir if any?
jane weckesser
01:27:12
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?
Jacqueline Ford
01:27:23
We do rolling discharge for vaginal at 36 hours and 48 hours for c/s
Svitlana Koroleva
01:29:24
where do mother obtaining the 2 negative tests after discharge?
Deborah Campbell
01:29:40
Montefiore has the same NICU visitation policy as NYP
Edmund LaGamma
01:29:42
I can comment on a neonatologist survey Ed LaGamma
Neila Hernandez
01:29:44
How many days apart are you reswabbing COVID+ NICU moms?
Svitlana Koroleva
01:31:12
for Covid + mothers with NICU babies, do you provide tests in the hospital?
Dena Goffman
01:31:18
2 swabs at least 24 hrs apart if swab based approach
Svitlana Koroleva
01:31:47
DOH is not willing to test those with no symptoms.
Svitlana Koroleva
01:32:03
we are trying to figure out how to swab mothers
Svitlana Koroleva
01:32:25
when they leave the hospital
Erin Gretzinger
01:33:23
Thank you for those final words of inspiration.
Deborah Campbell
01:35:44
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
whitney hall
01:35:47
Thanks all.