Tailoring the response to COVID-19: experiences of an inner city maternity unit with a virtual patient surveillance approach.

This study outlines the characteristics and outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present the success of our 'COVID Surveillance Team' - a dedicated team of midwives and medics that regularly contact patients, identifying early any need for escalation of care. Data were collected prospectively from March to September 2020. Patients are followed up by our team for 14 days following diagnosis, via telephone. Maternal and neonatal outcomes were studied. Fifty-five women were diagnosed with COVID-19. 39/55 (70.9%) were of BAME background. 10/55 (18%) had medical comorbidities. 35/55 (63.6%) were diagnosed in the 3rd trimester, 7/55 (12.7%) were postnatal. Three women (5.4%) required critical care unit admission. One was transferred to a tertiary centre for extra-corporeal membrane oxygenation (ECMO), one patient died. Of the 43 deliveries, 28 (65.1%) underwent caesarean section. 11/45 (24.4%) of babies were born preterm. Eight babies were tested for COVID-19, one was positive. Our study demonstrates most pregnant women suffer mild illness, with no adverse outcomes for mother or neonate. We highlight the success of our COVID surveillance team, that should be considered best practice and consideration should be given for adoption by other maternity units to enhance patient safety.Impact StatementWhat is already known on this subject? Many studies present maternal and neonatal characteristics and outcomes of COVID-19 infection in the pregnant population, demonstrating most patients suffer mild disease with minimal adverse outcomes.What do the results of this study add? We highlight the important work of our COVID surveillance team, and the positive impact it has had on the wellbeing and safety of our women. We believe we are the first maternity unit in the UK to adopt and report on a virtual patient surveillance approach supporting our patients and leading to increased patient safety.What are the implications of these findings for clinical practice and/or further research? Our surveillance team has proved very successful and has been described as exemplar by NHS England and promoted as best practice. This approach could be adopted by other units, within the UK and further afield, for the benefit of women's health and safety. The team has shared their guidance and standard operating procedure with maternity units across the UK.

Shortness of breath in a patient with inflammatory bowel disease.

Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunocompromised patients. Although immunosuppressive therapy is the mainstay of medical treatment for patients with inflammatory bowel disease, the importance of CMV as a cause of pneumonia in this group is less well recognised. This case report presents a case of shortness of breath, dyspnoea and fever in a 51-year-old man with Crohn's disease on azathioprine and highlights the importance of considering CMV as a cause of pneumonia in this group.