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Hello, everyone. Welcome to today’s webinar. Please feel free to submit your questions via the chat function.

hello

should be be wearing n95s for all pt encounters?

Greetings, Ancient Song has been made aware that at two public hospitals newborns are being separated from their parents immediate postpartum for 14 days even when no signs of COVID-19 is present. What is the current policy on immediate postpartum care of pregnant people and newborns? Give Thanks Chanel Porchia-Albert

should babies be a nursery together with other babies or stay in mothers room together knowing some patients are asymptomatic and may develop symptoms/disease later? what are other facilites doing?

Please feel free to submit questions through the chat.

Anyone considering early discharge for healthy mom/baby with uncomplicated pregnancy and delivery?

Are there any guidelines around the pregnant patient needing or requiring a ventilator?

We are discharging women when medically and socially ready but including PPD1 for NSVD and POD2 for CD

NYS stays that a support person is allowed but can not be a PUI or COVID+ but what if the patient themselves is a PUI or covid. then is the support person allowed to be a PUI or covid? my hospital is inclined to let a covid + support person in if the patient themselves is.

once we have determined that we have a mom that is Covid-19 what would be standard of care for postpartum regarding the newborn?

Are there any RN staffing changes being made to handle the covid pts??

are any other hospitals doing any simulations as I saw in the ACOG Covid preparedness manual

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on the ambulatory side, I have RNs working telephonically working from home to preserve the work force. I provide my nursing director with a list of RNs that could be reassigned to inpatient

are there any limitations that doulas need to be aware of in supporting clients virtually within the labor room?

Hi this is Adriann Can you unmute me?

Hi, Adriann. Will do.

You should be all set now.

How do we know second stage of labor is not aerosol generating?

http://www.ihi.org/communities/blogs/covid-pandemic-conserving-personal-protective-equipment?utm_source=hs_email&utm_medium=Feature&utm_campaign=2020_TW_Test&utm_content=Recs_PPE&_hsenc=p2ANqtz-_MfVCVTjCxYh-4s6OqQYT_yKGAc0SgG3rW30-yTmb6ir39rdh2YNibsiAN41iN3TAmXLXpPaUOlcOh058v4LWMmTQRZA&_hsmi=85425648

To address second question, I have struggled to reassure my department regarding PPE, particularly N95 use. Nurses and Docs have continually expressed dissatisfaction with the CDC guidelines, claiming safety is not at the forefront of such guidelines. Our hospital insists on keeping with CDC recs before releasing N95s. How do I reconcile these two parties?

Is anyone masking patient and support person -- either homemade, surgical, or n-95?

is this for ALL patients in the second stage, or specific to only PUIs/positive COVID patietns?

masking birth partner with procedural mask

All patients and support individuals masked with surgical facemask

since not enough tests -- asking re -all patients/support people

we are also masking all patients and support people with surgical masks

This feels unfair to the rest of hospitals in NYS who are being told there are not enough to start; that we need to preserve them for the positives- and then to hear that other hospitals are using them all the time.

I agree with Jenn Carey; we are currently preserving for only RT (med neb, intubation, etc) + COVID pts

Agreed Jenn Carey. We have a lock box with 5 masks of each size for a entire floor of RN's

Please comment on testing all patients in labor and delivery with rapid turn around tests in effort to preserve scarce PPE and plan the postpartum period with the neonate?

How do you manage the newborn of a positive patient on postpartum ?

are all patients on full PPE until you get resuts

Obtaining swabs for ALL L&D admitted patients?

Yesterday Pres Trump stated "millions of masks" are being distributed to NY hospitals. Any idea where those are being sent? He even suggested they are being hoarded in NY somewhere.

Majority of our patients have been completely asymptomatic on presentation. All patients are tested on admission but our results come back over 24hrs.

Yes all admitted L&D patients

Are you concerned about false negative results with swabs on asymptomatic patients?

Are the babies of PUI roomed in with the mom while hospitalized?

Thank you Marino Poliseno. Can you tell me if this is a recommendation from CDC?

Mom enters w/ fever but w/o URI signs? Test or not?

We are seeing fever as the only or first sign. Would swab for fever

We have a room designated for all newborns of PUIs and positive patients staffed with NICU nurses.

Dr Goffman Do your patients stay on full isolation while results pending?

Hi Dr. Goffman, what has your positive rate been for the universal screening to date?

We are also swabbing for fever in labor/postpartum.

What level of PPE do you use for support person of PUI or positive patient

Asymptomatic women are placed in a low suspicion group. Mom, partner and providers masked. Eye shield added for NP swabs and full gown/eyeshield for delivery.

How would you handle a mother who is covid + and refuses to have her baby isolated away from her?

I thought DOH said you have to allow a support person?

DOH did say allow support person, but not if sick

Yes

where are the support person's screening values recorded?

for COV19+ patient support person must stay in the patients room

We are recording support person's values in patient's chart.

This is Leah at upstate-we have limited to 2 nurses and 2 docs to conserve PPE

what type of oxygen delivery system is best for mother during labor? nasal canula or nonrebreather mask?

rooming in with separation by curtain

We have a log that screens support person's responses and temperature q 12 hours, place pt's ID label on sheet and this gets included in pt's paper chart for scanning in HIM

DOH 3/27 document last paragraph states... L&D support person MUST be asymptomatic, not suspected, nor recently confirmed.

Evidence is weak on effectiveness of oxygen -- so our hospital is not doing oxygen as routine response to labor events - minimizing droplets, disposal of tubing etc.... cleaning time

How about the use of nasal prong oxygen in the OR’s during cesarean sections or while pushing? Better to use rebreathers?

Not using oxygen and not using nitrous oxide anymore

Are you separating PUI babies form babies of COV. + moms?

We are not using oxygen or nitrous oxide either

question about doula support virual came up earlier

are there any virtual restrictions to providing support in the labor room that in the case someone does not have support or if the laboring person is getting virtual doula support?

No oxygen for fetal indications

how are you keeping track of covid results?

No oxygen for all laboring patient or COVID pt?

should Covid + patients be Inductions at 39 weeks?

There has been ongoing discussion at our hospital about discontinuing elective non-medically indicated inductions at 39+ weeks. Rationale: reducing length of stay (and to reduce risk of depleting resources during surge).

I think limiting elective inductions is a wise move.

Are we continuing to practice delayed cord clamping?

one great use of Doulas should be with the patient at her home to keep her in the home until in active labor.

the IPAD initiative is an excellent idea !

thank you

you are welcome

Stopping elective inductions also helps to conserve staff (1:1 ratio for Pitocin)

what about IOL for AMA?

very creative with iv pumps. do you have central fetal heart rate monitoring?

12 hour discharge?

what about 12 hour discharge?

Please address recommendations for AP visit in low and high risk setting. What are recommendations for fetal monitoring , (ie DM, HTN third trimester)

So are you discharging babies to the home of covid positive mom?

How are you following mothers who are Covid positive, but remain pregnant, as outpatients?

baby must be tested for NYS screening at 25 hours of life - Peds Team has to buy into that if done as outpatient

Covid positive outpatients being followed closely with Virtual visits by dedicated team.

Thanks Dr. Goffman

Our pediatricians are performing repeat NYS screening for those infants requiring this

we have also stopped oxygen as well a while ago

As a reminder, if you have questions after this webinar, please contact me at cchristakis@ny.acog.org

are you using VNS or home nursing for patient follow-up or your own nursing staff?

Category 2 tracing can be secondary to worsening maternal respiratory function

Is anyone talking with their ethics or ventilator allocation planning teams about plans for when ventilators are not sufficient for patients needing them? What are you advising?

We are not using VNS -- uncertain whether they would do this follow-up during this crisis.

Does the decision to give or not give oxygen differ for units that have a surgical suite on the labor unit and those that don't and need to transfer the patient to the OR?

Feel free to send algorithms to NYSPQC@health.ny.gov and we will compile and share.

Where are those simulation information available?

its so not intuitive! :)

NYS TaskForce on Life and Law published ventilator allocation guidelines in 2015. Not sure OB patients were specifically addressed in the allocation guidelines

covid-19 obstetric preparedness manual

has simulations

NYS Guideline 2015 built on flu -- doesn't address this specific issue -- seems covid + need more than 48 hours on vent usually to have effect

On a recent transfer in, I noticed that management of the actual patient chart was a problem. it was in the stretcher with the patient, then ended up in theroom

i would avoid use of cautery during cesarean section unless a smoke evacuator present

We would like to test all women as they present to L&D but we do not do our own testing and have a limited number of viral media from DOH. Reserved for symptomatic patients throughout hospital.

Can share ACOG simulation working group simulations we developed

yesterday we started screening all Ob admissions

We are only testing symptomatic patients

Only testing patients with symptoms

We screen all admitted OB patients at Columbia.

Will a summary regarding this webinar be emailed or posted on the website?

Thanks for allowing me to participate. We screen symptomatic women. We don't have the faster screening available for testing.

THANK YOU ALL SO MUCH!!

The webinar has been recorded and will be made available following the webinar. We will also disseminate algorithms we receive and other resources.

cchristakis@ny.acog.org

Thanks so much!

Grateful to participate

thank you!!

Results for our testing take 5 to 7 days for turnaround

We are considering testing all pregnant patients but resources are limited

thank you. this was wonderful

Thank you

thank you