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)