Ensuring the Safety of the Pregnant Patient during the COVID-19 Pandemic

Dr. Khadeja Haye is TeamHealth’s national medical director of OB/GYN hospitalist programs. She has extensive experience in managing hospital-based programs, physician leadership and development, and in working with hospitals across the country to develop procedures and protocols that improve clinical quality and patient safety.

KH: The pandemic has impacted all facets of patient care in hospitals across the country, including almost every aspect of care for obstetric patients. There are some clinical considerations related to caring for pregnant patients that are unique to this specialty. Obstetrics is one of the specialties where a response time of just a few minutes can drastically impact the outcomes for patients. Pregnant patients are also accustomed to having support during the labor process, so the visitor limitations imposed by hospitals (while understandable) have had a significant impact on the experience pregnant women have come to expect. A potential unexpected benefit involved the move toward early discharge for post-partum patients, resulting in shorter length of stays.

KH: While there may have been an influx of COVID-19 positive patients, many emergency departments (ED) noticed a significant decline in their overall patient volume early in the pandemic. We also noticed a decrease in the number of OB/GYN consults coming from the ED. As a result, there was a frightening trend of patients presenting to the ED with acute gynecologic emergencies. Most notably, we noticed an increase in the number of patients presenting with surgical emergencies that could have possibly been prevented if they had presented earlier. Many of our Obstetric Emergency (OB-ED) departments experienced a similar trend of decreased patient volumes in the spring. There were a number of instances of pregnant patients not presenting to the OB-ED in time, and giving birth outside of the hospital.

KH: There is emerging data from the CDC suggesting that pregnant women are at increased risk of severe illness due to COVID-19 compared to non-pregnant women. A recent CDC report noted intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death were more likely in pregnant women than in non-pregnant women. Healthcare personnel should keep this increased risk in mind when assessing and caring for pregnant women with COVID-19, especially those who are symptomatic. Pregnant women should also be counseled regarding this increased risk when they present to the ED or L&D.

KH: Caring for pregnant COVID-19 positive patients should involve a multidisciplinary approach. Consideration of a universal testing protocol for all admitted pregnant patients should be explored, especially given the potential rate of asymptomatic COVID-19 positive patients is greater than 10%. An emphasis should also be placed on policies and procedures that address various patient care scenarios. These activities will help identify the key resources needed and how best to obtain them before a critical need arises. This should include an assessment of nurse and physician staffing, ensuring everyone on the care team is aware of the personal protective equipment (PPE) requirements, transportation of pregnant patients through the hospital while ensuring proper fetal monitoring, isolation room locations, logistics of post-partum couplet care, etc.

KH: TeamHealth puts a great deal of effort in to providing resources for our clinicians. Bi-weekly planning calls were conducted to discuss staffing plans and how best to protect our frontline clinicians. Our clinical and operations leaders engage in consistent communication with our clinicians. Clinicians receive PPE when needed and support calls are placed to assess their emotional needs. A multi-specialty emerging infectious disease task force was developed and included OB/GYN representation and a review of available data pertaining to COVID-19 and pregnancy. Our OB/GYN Hospitalists have access to clinical information to guide best practices and we share access to those best practices with our clients.
 

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