Patient care:
After closing the routine antenatal and gynaecology clinics along with other speciality clinics, the hospital system kept some clinics open to refill prescriptions for patients with chronic diseases. During the lockdown, our aim was to continue providing care for all our patients (Table 1).
Patients with positive COVID-19:
We admitted 4 pregnant women who were confirmed positive for COVID-19. Patients were cared for in a COVID-19 special ward, the antenatal foetal and maternal observation remained normal. 2 of those patients required delivery by Caesarean section.
Patients with acute obstetrics and gynaecology complaints were referred by official authorities, media, and front desk personnel to visit the emergency department (ED), where an in-house team is available 24/7 to evaluate these patients. In general, inpatients were kept in the hospital for the lowest number of days possible without compromising their care to decrease their chance of getting hospital-acquired COVID-19.
Although antenatal clinics were deferred and rescheduled, the previously arranged induction of labour, and elective Cesarean section (CS) cases, were undertaken on time without delay.
Pregnant women who had urgent questions about their conditions were able to reach consultants and residents by telephone, as their phone numbers were available at the front desk and were given to patients and their families who contacted the hospital. The consultants and residents also used text messaging via social media to address some of the patients’ issues. Patients whose problems were not solved over the phone were directed to the ED for further evaluation. Our midwifery team created a Facebook page to facilitate contact to all our registered pregnant women, the page was open for non-registered pregnant women as well. The page gained 3000 followers. Questions and quires, were addressed by both midwives and consultants.
We developed a triaging system based on COVID-19 risks. Risk factors covered the risk of exposure to COVID-19.
Pregnant cases with positive test were cared for in COVID-19 special suite, 2 of those patients required delivery by CS, CS was performed in the special suite, Spinal anaesthesia was used to reduce risk of staff exposure.
The entire staff took the necessary precautions and personal protective equipment (PPE), multiple swaps were taken from the amniotic fluid and the baby, all swaps were reported negative. The 2 newborns were separated from their mothers to reduce risk of acquiring infection. Both deliveries were uneventful and the babies were healthy. The two mothers recovered from COVID-19 and were discharged home.
A pathway colour-coded Red was designated for pregnant women who live in closed areas, had history of travel, had contact with virus-positive patients, or had mild respiratory symptoms; Those patients were admitted into isolation rooms, and cared for by a separate team, taking all the precautions and wearing the appropriate PPE.
A pathway colour-coded Green was designated for low risk maternity women who have been cared as routine.
Although routine gynaecology clinics were deferred, we managed to maintain our care for cancer patients. Several measures were taken to reduce risk of infection; such as Laparoscopic procedures like total laparoscopic hysterectomy (TLH) converted to open approach, and shortening of the length of stay, with telephone follow up.
Table 1