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dc.contributor.authorAshokka, Balakrishnanen_US
dc.contributor.authorLoh, May-Hanen_US
dc.contributor.authorTan, Cher Hengen_US
dc.contributor.authorSu, Lin Linen_US
dc.contributor.authorYoung, Barnaby Edwarden_US
dc.contributor.authorLye, David Chien Boonen_US
dc.contributor.authorBiswas, Arijiten_US
dc.contributor.authorIllanes, Sebastian E.en_US
dc.contributor.authorChoolani, Maheshen_US
dc.identifier.citationAshokka, B., Loh, M., Tan, C. H., Su, L. L., Young, B. E., Lye, D. C. B., Biswas, A., Illanes, S. E. & Choolani, M. (2020). Care of the pregnant woman with coronavirus disease 2019 in labor and delivery : anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. American Journal of Obstetrics and Gynecology, 223(1), 66-74.E3.
dc.description.abstractCoronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has been declared a pandemic by the World Health Organization. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). This is in contrast to earlier data that showed good maternal and neonatal outcomes. Clinical manifestations of coronavirus disease 2019 include features of acute respiratory illnesses. Typical radiologic findings consists of patchy infiltrates on chest radiograph and ground glass opacities on computed tomography scan of the chest. Patients who are pregnant may present with atypical features such as the absence of fever as well as leukocytosis. Confirmation of coronavirus disease 2019 is by reverse transcriptase-polymerized chain reaction from upper airway swabs. When the reverse transcriptase-polymerized chain reaction test result is negative in suspect cases, chest imaging should be considered. A pregnant woman with coronavirus disease 2019 is at the greatest risk when she is in labor, especially if she is acutely ill. We present an algorithm of care for the acutely ill parturient and guidelines for the protection of the healthcare team who is caring for the patient. Key decisions are made based on the presence of maternal and/or fetal compromise, adequacy of maternal oxygenation (SpO2 >93%) and stability of maternal blood pressure. Although vertical transmission is unlikely, there must be measures in place to prevent neonatal infections. Routine birth processes such as delayed cord clamping and skin-to-skin bonding between mother and newborn need to be revised. Considerations can be made to allow the use of screened donated breast milk from mothers who are free of coronavirus disease 2019. We present management strategies derived from best available evidence to provide guidance in caring for the high-risk and acutely ill parturient. These include protection of the healthcare workers caring for the coronavirus disease 2019 gravida, establishing a diagnosis in symptomatic cases, deciding between reverse transcriptase-polymerized chain reaction and chest imaging, and management of the unwell parturient.en_US
dc.relation.ispartofAmerican Journal of Obstetrics and Gynecologyen_US
dc.rights© 2020 Elsevier Inc. All rights reserved.en_US
dc.titleCare of the pregnant woman with coronavirus disease 2019 in labor and delivery : anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnelen_US
dc.typeJournal Articleen
dc.contributor.schoolLee Kong Chian School of Medicine (LKCMedicine)en_US
dc.contributor.organizationTan Tock Seng Hospitalen_US
dc.contributor.organizationNational Centre for Infectious Diseasesen_US
dc.subject.keywordsAngiotensin-converting Enzyme 2en_US
dc.subject.keywordsAcute Respiratory Distress Syndromeen_US
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