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.