Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

Introduction This study aimed to investigate the knowledge and expectations of pregnant women on perinatal care during the coronavirus disease 2019 (COVID-19) pandemic. Methods A cross-sectional survey was conducted among pregnant women ≥21 years, without a history of confirmed COVID-19, attending antenatal clinics between August and September 2020 via a secure online platform. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic. Results A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4;range 22–43 years). The median gestational age was 25 weeks (range 4–40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. Although 46% were concerned about increased transmission risk with antenatal clinic visits, only 37% were agreeable to teleconferencing of clinic appointments. Maternal age >35 years was significantly associated with agreement with separation of mother-infant after birth [AOR 1.89 (95% CI 1.05, 3.39)], restrictions of visitors during the postnatal period [1.92 (1.05, 3.49)] and having their confinement practices were affected [2.3 (1.26, 4.17)]. Pregnant women who were multiparous disagreed that breastfeeding was safe in women with active COVID-19 [0.42 (0.23, 0.75)]. Conclusions There was significant uncertainty about the optimal delivery method and safety of breastfeeding with COVID-19 among expectant mothers, along with variable agreement with alterations to routine perinatal care.

Being Prepared During the Evolving COVID-19 Pandemic: A Neonatal Experience in Training and Simulation.

Background: Rapid spread of the COVID-19 pandemic raised an urgent need for preparedness in the healthcare sector, including training of healthcare workers to cope with the burden of infected cases while ensuring proper protection of themselves. Improper infection prevention and control measures were key reasons for infection in healthcare workers during the early phase of the outbreak. Objectives/Methods: This paper describes the combined approach of 3 restructured hospitals in Singapore in preparing and training neonatal healthcare workers' during the COVID-19 pandemic crisis, as well as lessons learnt during this process. Results: Information sharing was conducted in the form of e-learning, emphasizing on topics like disease knowledge and infection prevention and control procedures. Skills and competency training were carried out in the form of simulation, with sessions scaled into 4 levels progressing from individual task training to larger group simulations involving multiple disciplines and departments. Challenges encountered included information fatigue by large amount of constantly changing information and multiple amendments to workflows as more information arose. Difficulties conducting training and simulation sessions included restriction of group size to mitigate infection risk amongst participants and the limited supply of personal protective equipment prioritized for direct patient care. Conclusion: Healthcare institutions should ensure adequate dissemination of conceptual knowledge as well as skills competency training of staff in infection control measures for the protection of healthcare workers and patient safety. Ongoing training for sustainability of knowledge and skills, while adapting to the rapidly evolving situation is important in the preparation for future outbreaks.

Knowledge, attitudes and expectations of perinatal care during the COVID-19 pandemic

BackgroundThere is limited evidence regarding the transmission SARS-CoV-2 from mother to infant, as well as the optimal management of infected women and infant during pregnancy, labor and early postnatal period. The knowledge, concerns and expectations of women with regards to perinatal and neonatal care during this current COVID-19 pandemic is currently unclear.ObjectivesThis study aimed to investigate the knowledge and expectations of pregnant women on perinatal and neonatal care during the coronavirus disease 2019 (COVID-19) pandemic in Singapore.MethodsA cross-sectional survey was administered via a secure online platform to pregnant women attending the antenatal clinics between August 2020 and September 2020. Participants aged >21 years who were pregnant and had no history of confirmed COVID-19 were included in the study. The survey consisted of 10 questions formulated to evaluate the knowledge and expectations of these women on the perinatal and neonatal care during this current pandemic.ResultsA total of 313 pregnant women completed the survey during the study period. The mean age of the participants was 30 years (SD 4;range 22–43 years). The median gestational age of women at survey participation was 25 weeks (range 4–40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of hand hygiene and face masking (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 to the unborn foetus was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant women with active COVID-19. There was no significant association between the sociodemographic factors evaluated and maternal agreement with the possibility of in-utero SARS-CoV-2 transmission and the risk associated with vaginal delivery in women with COVID-19. Although 46% of participants were concerned about the increased risk of contracting COVID-19 during routine clinic appointments at the hospital, only 37% of the cohort were agreeable with teleconferencing of clinic appointments. More than half (56%) of the participants reported that their postnatal confinement plans were affected by the current pandemic.ConclusionsOur survey revealed that majority of participants were aware of modes of transmission and the prevention strategies of SARS-CoV-2, there were however significant gaps identified in their knowledge related to the risk of in-utero transmission and safety of breast feeding along with significant variability to the agreement with alterations to the perinatal care. For best practice we recommend provision of evidence based information early to expectant mothers by the healthcare professionals to reduce misinformation and anxiety amongst pregnant women related to the current pandemic.

Guidance for the clinical management of infants born to mothers with suspected/confirmed COVID-19 in Singapore.

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.