3. Intrapartum Analgesia
The isolation rooms in our institution are not equipped to deliver
Entonox. Even if available, our institution does not have single-patient
microbiological filters which are recommended for the delivery of
Entonox in this situation. (10) The immediate implication is the
requirement for an attending anaesthesia team to provide an epidural
service which is not contraindicated. They are also required to observe
similar PPE requirements.
4. Operating Theatre
a. A dedicated operating theatre was designated for COVID-19 suspected
or infected cases. This was located at some distance from both the
isolation ward as well as labour ward. Hence, transferring the patient
requiring caesarean section is time-consuming. In addition, the route
from ward to operating theatre had to be standardised and secured to
prevent cross contamination.
b. Regional anaesthesia is preferred over general anaesthesia given the
aerosol generating nature of the latter. (10) It is important to exclude
thrombocytopenia in patients with severe COVID-19.(11)
5. Perinatal Care
a. Despite the absence of evidence at the time, the authors felt it
prudent to have a separate room or designated area as far as reasonably
possible from the mother, for the neonatal team to receive the newborn
infant. This room or area needs to be equipped with the necessary
neonatal resuscitative equipment including an open-care unit with the
appropriate oxygen and air supplies, suctioning set-up, and a transport
incubator. To minimise exposure, the number of neonatal personnel should
be aligned with the anticipated neonatal needs. Full PPE is required in
preparation for the possible naso-oropharyngeal suctioning and mask
positive pressure ventilation. Contingency plans for a multiple
pregnancy delivery were also made.
b. The authors will discuss the limited evidence when counselling
mothers for: 1. Delayed cord clamping, 2. Skin-to-skin contact and 3.
Breastfeeding. The authors erred on the side of caution in the interest
of minimising mother-to-child transmission. We suggested immediate cord
clamping of the umbilical cord, avoidance of skin-to-skin contact and
direct breastfeeding. (9,12,13) However, if the mother was keen to have
any of these, these were permitted with precautions such as good hand
hygiene and wearing a surgical mask. (10,14,15)