Methods
We first studied the epidemiology and the pathogenicity of the COVID-19 virus since its outbreak in China in December 2019. The first imported case of COVID-19 infection was diagnosed in January 2020, prompting the need for contingency plans to manage suspected or infected mothers presenting to our maternity centre. Our centre is a tertiary referral centre for high-risk obstetric cases in Singapore. A detailed examination of our previous experience during the SARS outbreak in 2003 was conducted. We noted a difference in the virulence, pathogenicity and transmission between SARS and COVID-19 viruses. The primary mode of transmission for SARS was airborne while the mode of transmission of COVID-19 is by droplet,(7) yet the latter is significantly more contagious.
We enlisted multi-disciplinary collaborations with the High-Risk Obstetrics Unit, Labour Ward, Departments of Emergency Medicine, Infection Prevention and Epidemiology, Neonatal and Developmental Medicine, Anaesthesiology, the Operating Theatre Unit, the Division of Nursing and the Hospital’s Security Department.
With expert advice and guidance from the various specialty departments, we identified 4 primary strategies which formed the basis of constructing our protocols and workflow processes. These were1. Early detection of suspected cases and triaging, 2. Isolation and infection containment 3. Intrapartum care and 4. Training. Our protocols can be found in Figures S1 and S2.