Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Am J Perinatol. 2020 Jun;37(8):854-856. doi: 10.1055/s-0040-1709689. Epub 2020 Apr 10.
The novel coronavirus disease 2019 (COVID-19) is spreading fast and is affecting the clinical workers at much higher risk than the general population. Little is known about COVID-19 effect on pregnant women; however, the emerging evidence suggests they may be at high risk of asymptomatic disease. In light of projected shortage of personal protective equipment (PPE), there is an aggressive attempt at conservation. In obstetrics, the guidelines on PPE use are controversial and differ among hospitals, globally, as well as nationally. The centers for disease control and prevention (CDC) recommend using N95 respirators, which are respirators that offer a higher level of protection instead of a facemask for when performing or present for an aerosol-generating procedures (AGP). However, the second stage of labor is not considered an AGP. The second stage of labor can last up to 4 hours. During that time, labor and delivery personnel is in close contact to patients, who are exerting extreme effort during and frequently blow out their breath, cough, shout, and vomit, all of which put the health care team at risk, considering that COVID-19 transmission occurs through aerosol generated by coughing and sneezing. The CDC and the American College of Obstetricians and Gynecologists (ACOG) do not provide clarification on the use of N95 during the second stage. We recommend that labor and delivery personnel have the utmost caution and be granted the protection they need to protect themselves and other patients. This includes providing labor and delivery personnel full PPE including N95 for the second stage of labor. This is critical to ensure the adequate protection for health care workers and to prevent spread to other health care workers and patients. KEY POINTS: · Second stage of labor exposes providers to aerosol.. · COVID-19 risk during second stage of labor is high.. · N95 should be used during second stage of labor..
新型冠状病毒病 2019（COVID-19）正在迅速传播，对临床工作人员的影响比一般人群高得多。关于 COVID-19 对孕妇的影响知之甚少；然而，新出现的证据表明，她们可能面临无症状疾病的高风险。鉴于预计个人防护设备（PPE）短缺，正在积极进行保护。在产科，关于 PPE 使用的指南存在争议，在全球以及国家范围内，不同医院之间的指南也存在差异。疾病控制与预防中心（CDC）建议使用 N95 呼吸器，这是一种提供更高保护水平的呼吸器，而不是在进行或出现气溶胶产生程序（AGP）时使用口罩。然而，第二产程不被认为是 AGP。第二产程可持续长达 4 小时。在此期间，分娩和助产人员与患者密切接触，患者在分娩过程中会竭尽全力，经常呼气、咳嗽、呼喊和呕吐，所有这些都会使医疗团队面临风险，因为 COVID-19 通过咳嗽和打喷嚏产生的气溶胶传播。CDC 和美国妇产科医师学会（ACOG）并未就第二产程中使用 N95 提供澄清。我们建议分娩和助产人员要格外小心，并给予他们保护自己和其他患者所需的保护。这包括为分娩和助产人员提供全套 PPE，包括第二产程使用的 N95。这对于确保医护人员得到充分保护，防止传播给其他医护人员和患者至关重要。要点：· 第二产程使提供者暴露于气溶胶中。· COVID-19 在第二产程中的风险很高。· 第二产程应使用 N95。
