key: cord-0861917-qz9a88nu
authors: Dotters-Katz, Sarah; Harris, Hailey; Wheeler, Sarahn M.; Swamy, Geeta K.; Hughes, Brenna L.
title: Specialized prenatal care delivery for COVID-19 exposed or infected pregnant women
date: 2020-11-20
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.11.025
sha: cba9803dbf8ec6ab9748e52a86d9d82b6edebd35
doc_id: 861917
cord_uid: qz9a88nu

nan

Objective: 29 Due to the COVID-19 pandemic, medical practices are adjusting care delivery to minimize 30 exposure risk for patients and healthcare workers. Prenatal care presents an interesting 31 challenge, as many visits must occur in person and should not be delayed. The severity of 32 COVID-19 in pregnancy remains unclear, therefore COVID positive and quarantined COVID 33 exposed pregnant women need access to essential obstetric care and evaluation to ensure 34 disease stability. While telehealth can be used to provide care and reduce exposure, there are 35 circumstances when in person visits are indicated. 1 In some cases, pregnant women with COVID 36

have been unable to receive needed prenatal care due to insufficient infection control 37

measures. Thus, the objective of this study is to demonstrate feasibility of a 'cohorted' prenatal 38 care model which isolates COVID positive and quarantined COVID exposed pregnant in a 39 separate clinic location, in order to provide obstetrical care while minimizing exposure risk. 40 41

Study Design: 42 We conducted an IRB-approved, retrospective cohort study of gravid women from a single 43 academic health-system's OB COVID-19 clinic. Women receiving prenatal care within a three-44

hospital system, with COVID or at high-risk based on the ACOG COVID algorithm 2 were eligible 45 for care in OB COVID clinic. Nurses in each site providing obstetric care were trained on 46

following the algorithm, ordering testing, and scheduling. Clinic services offered in a location 47

with car-side check-in, and separate entrance and bathrooms. The clinic was staffed by a 48 consistent team with training in donning and doffing (2 medical assistants and one Maternal-49 fetal-medicine specialist). One staff was designated as PPE observer/escort. Home pulse 50 oximeters were distributed when indicated. Following resolution of COVID quarantine, patients 51 resumed care with their primary obstetrical practice. Demographic data, pregnancy 52 complications and outcomes, were abstracted. Data analyzed using descriptive statistics. 53 54

Results: Between March 18 th and July 30 th 2020 85 women were seen in OB-COVID clinic, of 55 whom 63 had COVID-19. 56 57 72 patients had a known exposure: 25(34%) were family-related, 20(27%) were work-related, 58

another 27(37%) had unknown exposure, and 1(1.3%) were travel-related. Of those with known 59 exposure etiology, those with family-related(80%) and work-related(75%) exposures were most 60 likely to test positive. Latinx women were more likely to have COVID than other racial/ethnic 61 groups (p<0.01) (Table) . 62 63

Among the 63 COVID-positive women, 6(9.5%) were asymptomatic, 49(77.8%) had mild, 64 6(9.5%) had moderate, and 2(3.2%) had severe disease. Only 7 patients required 65

hospitalization. Length of stay ranged from 1-6 days, and 3 patients received Remdesivir, none 66 received corticosteroids. No patients developed fetal growth restriction and 28/63(44%) of the 67 women have delivered (Table) . Three healthcare workers developed COVID infection. 68 69

Conclusion: 'Cohorted' obstetric care during the COVID pandemic allows an algorithm-driven 70 method of providing prenatal care for COVID positive and quarantined COVID exposed 71 pregnant while minimizing exposures in clinics providing routine prenatal care. 3 The clinic 72 serves as a resource for a three-hospital health system for pregnancy-related COVID-19 queries. 73

This approach optimizes resource allocation across the health system, develops experts in 74 donning and doffing personal protective equipment, and ensures that patients with COVID-19 75 in pregnancy receive consistent assessment and care recommendations. 76 77 78 79 

Telehealth for High-Risk Pregnancies in the Setting of the 81 COVID-19 Pandemic

AND PUBLIC HEALTH 83 PREPAREDNESS EXPERT WORK GROUP. COVID-19 FAQs for Obstetrician-Gynecologists

American College of Obstetricians and Gynecologists' Immunization ID, 85 and Public Health Preparedness Expert Work Group

Outpatient Assessment and Management for Pregnant Women With Suspected or 87

In: American College of Obstetricians and 88

Gynecologists' Immunization ID, and Public Health Preparedness Expert Work Group