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Obstetrics in the Time of Coronavirus: A Tertiary Maternity Centre's Preparations and Experience During the COVID-19 Pandemic

Objective Since the outbreak of Coronavirus Disease 2019 (COVID-19) in Singapore in January 2020, our maternity centre at Singapore General Hospital has devised and implemented contingency protocols to manage COVID-19 suspected or infected pregnant mothers. These aimed to deliver effective care while ensuring the safety of our front-line healthcare workers. Methods The epidemiology and pathogenicity of SARS-COV-2 was compared to the Severe Acute Respiratory Syndrome outbreak in 2003. Our protocols were constructed following multidisciplinary discussions. These workflow processes include triage, isolation, determination of admission criteria and subsequent secured transfers to dedicated isolation wards. Intrapartum management policies including mode of delivery were reviewed with the focus on minimising maternal-fetal transmission. Postpartum care (breastfeeding and skin-to-skin contact) policies were re-evaluated. Results The Centre conducted several multidisciplinary in-situ simulations which identified potential latent threats and deficiencies in infection containment. These were gaps in communication and co-ordination between operating theatre, obstetrics and neonatal teams resulting in delayed transfers. A particular vulnerability was the consistent breaches observed in the donning and doffing of personal protective equipment. This led to a need for additional personnel to guide and police strict adherence among healthcare workers. Conclusion Operational readiness leverage on robust contingency protocols which must be subjected to simulation and scrutiny with subsequent revision. We recommend deploying additional supervisory manpower to maintain strict adherence to infection prevention protocols. Effective preparation is key in maintaining high clinical standards of obstetric care while ensuring safety of healthcare workers during this ongoing pandemic. Funding No funding nor conflicts of interest.