Seminars in perinatology
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Seminars in perinatology · Nov 2020
Building an obstetric intensive care unit during the COVID-19 pandemic at a tertiary hospital and selected maternal-fetal and delivery considerations.
During the novel Coronavirus Disease 2019 pandemic, New York City became an international epicenter for this highly infectious respiratory virus. In anticipation of the unfortunate reality of community spread and high disease burden, the Anesthesia and Obstetrics and Gynecology departments at NewYork-Presbyterian / Columbia University Irving Medical Center, an academic hospital system in Manhattan, created an Obstetric Intensive Care Unit on Labor and Delivery to defray volume from the hospital's preexisting intensive care units. Its purpose was threefold: (1) to accommodate the anticipated influx of critically ill pregnant and postpartum patients due to novel coronavirus, (2) to care for critically ill obstetric patients who would previously have been transferred to a non-obstetric intensive care unit, and (3) to continue caring for our usual census of pregnant and postpartum patients, who are novel Coronavirus negative and require a higher level of care. In this chapter, we share key operational details for the conversion of a non-intensive care space into an obstetric intensive care unit, with an emphasis on the infrastructure, personnel and workflow, as well as the goals for maternal and fetal monitoring.
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Seminars in perinatology · Nov 2020
What obstetricians should know about obstetric anesthesia during the COVID-19 pandemic.
The COVID-19 pandemic has prompted obstetric anesthesiologists to reconsider the ways in which basic anesthesia care is provided on the Labor and Delivery Unit. Suggested modifications include an added emphasis on avoiding general anesthesia, a strong encouragement to infected individuals to opt for early neuraxial analgesia, and the prevention of emergent cesarean delivery, whenever possible. Through team efforts, adopting these measures can have real effects on reducing the transmission of the viral illness and maintaining patient and caregiver safety in the labor room.
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Seminars in perinatology · Oct 2020
PPE during a pandemic: The experience of obtaining PPE and lessons learned from a department of obstetrics and gynecology in New York city.
The COVID-19 Pandemic is an ongoing crisis that has strained hospitals and health systems around the globe. The provision of personal protective equipment (PPE) for frontline healthcare workers is of utmost importance in sustaining an effective response to this crisis. ⋯ We describe the types of equipment used and aspects of PPE regulation and certification. We also describe our practices in extended use and reuse of PPE in light of the current understanding of the virus characteristics and modes of transmission.
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Seminars in perinatology · Oct 2020
ReviewGynecologic surgical considerations in the era of COVID-19.
The goal of this chapter is to review the various considerations necessary to safely perform gynecologic surgery in the setting of a viral pandemic. The ability to triage surgical cases at a time of reduced resources is facilitated by both state and national societal guidelines in addition to various scoring systems. Concerns by health care personnel of viral transmission intra-operatively require appropriate use of PPE and pre-operative COVID-19 testing. Implementation of mitigation strategies around aerosol-generating procedures such as laparoscopy protects health care personnel involved in the surgical care of the patient.
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The rapid spread of COVID-19 across the globe quickly and drastically changed the way we practice medicine. In order to respond to its effects, careful planning and implementation of new guidelines and protocols was crucial to ensure the safety of both patients and staff. Given the limitations of space, staff, and resources in the community hospitals, a centralized command center, robust lines of communication within the department and between departments, and contingency and surge planning in this setting were critical. This chapter focuses on the unique challenges of practicing within a Level II hospital during a global pandemic.