Patient care:
After closing the routine antenatal and gynaecology clinics along with
other speciality clinics, the hospital system kept some clinics open to
refill prescriptions for patients with chronic diseases. During the
lockdown, our aim was to continue providing care for all our patients
(Table 1).
Patients with positive COVID-19:
We admitted 4 pregnant women who were confirmed positive for COVID-19.
Patients were cared for in a COVID-19 special ward, the antenatal foetal
and maternal observation remained normal. 2 of those patients required
delivery by Caesarean section.
Patients with acute obstetrics and gynaecology complaints were referred
by official authorities, media, and front desk personnel to visit the
emergency department (ED), where an in-house team is available 24/7 to
evaluate these patients. In general, inpatients were kept in the
hospital for the lowest number of days possible without compromising
their care to decrease their chance of getting hospital-acquired
COVID-19.
Although antenatal clinics were deferred and rescheduled, the previously
arranged induction of labour, and elective Cesarean section (CS) cases,
were undertaken on time without delay.
Pregnant women who had urgent questions about their conditions were able
to reach consultants and residents by telephone, as their phone numbers
were available at the front desk and were given to patients and their
families who contacted the hospital. The consultants and residents also
used text messaging via social media to address some of the patients’
issues. Patients whose problems were not solved over the phone were
directed to the ED for further evaluation. Our midwifery team created a
Facebook page to facilitate contact to all our registered pregnant
women, the page was open for non-registered pregnant women as well. The
page gained 3000 followers. Questions and quires, were addressed by both
midwives and consultants.
We developed a triaging system based on COVID-19 risks. Risk factors
covered the risk of exposure to COVID-19.
Pregnant cases with positive test were cared for in COVID-19 special
suite, 2 of those patients required delivery by CS, CS was performed in
the special suite, Spinal anaesthesia was used to reduce risk of staff
exposure.
The entire staff took the necessary precautions and personal protective
equipment (PPE), multiple swaps were taken from the amniotic fluid and
the baby, all swaps were reported negative. The 2 newborns were
separated from their mothers to reduce risk of acquiring infection. Both
deliveries were uneventful and the babies were healthy. The two mothers
recovered from COVID-19 and were discharged home.
A pathway colour-coded Red was designated for pregnant women who live in
closed areas, had history of travel, had contact with virus-positive
patients, or had mild respiratory symptoms; Those patients were admitted
into isolation rooms, and cared for by a separate team, taking all the
precautions and wearing the appropriate PPE.
A pathway colour-coded Green was designated for low risk maternity women
who have been cared as routine.
Although routine gynaecology clinics were deferred, we managed to
maintain our care for cancer patients. Several measures were taken to
reduce risk of infection; such as Laparoscopic procedures like total
laparoscopic hysterectomy (TLH) converted to open approach, and
shortening of the length of stay, with telephone follow up.
Table 1