Intrapartum Care
Modifications in the routine intrapartum care of these pregnant women were made to align with the above principles of early triaging, isolation and infection containment. The following issues were identified:
1. Isolation Facilities
As the dedicated isolation wards and the isolation rooms at the Emergency Department are not equipped for vaginal delivery, arrangements had to be made to facilitate vaginal delivery in these sites. This includes the transfer of delivery and neonatal resuscitative equipment and intrapartum surveillance devices (such as electronic fetal monitors) from the labour ward to the designated isolation room. The list of equipment can be found in Table 1. Such transfers are time-consuming and may compromise maternal and fetal well-being in obstetric emergencies.
2. Donning and Doffing of PPE
a. Managing vaginal delivery in these isolation wards involve repeated donning and doffing of PPE for the attending healthcare workers entering and leaving these rooms. This also applies for staff changing shifts and also during patient transfers to operating theatre if a caesarean section was indicated. Moreover, assigning a dedicated midwife and delivery team decreases the overall effective manpower for obstetric service.
b. Labour progress can vary between pregnant mothers and this variability has implications for the care of the women. Long labours require more shift changes and repeated donning and doffing of PPE. Rapid labours may risk delivery in the absence of an attending staff given the time required to don the PPE.