Patients who develop respiratory symptoms should practice strict
respiratory hygiene including coughing and sneezing on a tissue paper
or a bent elbow. These patients should be wearing facemask and wait in
a designated area, at least six feet from other patients.
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Pregnant females should be isolated in a negative pressure room,
regardless whether they are suspected or confirmed
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Healthcare providers should take special care in wearing CDC
instructed personal protective equipment including N-95 respirators,
facial shields, gloves and gowns. The hospital’s infectious disease
department should be kept in loop at all times.
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Patient’s nasopharyngeal or oropharyngeal swabs should be collected
and sent to institutes running the SARS-CoV-2 RT-PCR testing. Contact
the designated COVID-19 government helpline for further information
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Make sure that the patient has limited access to relatives and
irrelevant staff in the isolation room
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Close monitoring of mother’s vital signs and diagnostic testing should
be done, since pregnancy itself is a high risk condition
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Fetal monitoring should be carried out regularly to ensure the
wellbeing of the fetus. It’s suggested to regularly to check fetal
heart rate and rate of contractions.
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In case the mother is in respiratory distress, consider the use of
early oxygen therapy with the goal of maintaining O2
saturation ≥95% and pO2 ≥ 70mmHg. In setting of
advancing respiratory failure, consider mechanical ventilation
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Use intravenous fluids conservatively unless cardiovascular
instability is present
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Screen for any other respiratory infection: viral and bacterial
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Consider empiric antimicrobial therapy (because of risk for
superimposed bacterial infections).
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Judicious use of corticosteroids should be done to promote fetal
maturity in the setting of an anticipated preterm delivery
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If septic shock is suspected, institute prompt, targeted management.
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Delivery and pregnancy termination decisions should be based on
gestational age, maternal condition, and fetal stability, and maternal
wishes. The clinical judgement should be done by multidisciplinary
team of obstetrics, neonatologists, intensive care specialists,
anesthetists and nursing staff.
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