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Maternity care for mothers and babies during the COVID …

Maternity and NeonatalClinical GuidelineQueensland Health Clinical Excellence Queensland Maternity care for mothers and babies during the COVID -19 pandemic Queensland Clinical Guideline: Maternity care for mothers and babies during the COVID -19 pandemic Refer to online version, destroy printed copies after use Page 2 of 33 Document title: Maternity care for mothers and babies during COVID -19 pandemic (formerly titled Perinatal care of suspected or confirmed COVID -19 pregnant women) Publication date: 22 November 2021 Document number: Document supplement: The document supplement is integral to and should be read in conjunction with this guideline. Amendments: Full version history is supplied in the document supplement.

or ongoing management • Advising consumers of their choices in an environment that is culturally appropriate and which ... • If concerned about type 2 diabetes: o . Continue self-monitoring . o . HbA1c at 4–6 months •Notify GP. Initial presentation after first trimester with risk factors.

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1 Maternity and NeonatalClinical GuidelineQueensland Health Clinical Excellence Queensland Maternity care for mothers and babies during the COVID -19 pandemic Queensland Clinical Guideline: Maternity care for mothers and babies during the COVID -19 pandemic Refer to online version, destroy printed copies after use Page 2 of 33 Document title: Maternity care for mothers and babies during COVID -19 pandemic (formerly titled Perinatal care of suspected or confirmed COVID -19 pregnant women) Publication date: 22 November 2021 Document number: Document supplement: The document supplement is integral to and should be read in conjunction with this guideline. Amendments: Full version history is supplied in the document supplement.

2 Amendment date: March 2022 Replaces document: Author: Queensland Clinical Guidelines Audience: Health professionals in Queensland public and private Maternity and neonatal services Review date: November 2026 Endorsed by: Queensland Clinical Guidelines Steering Committee Statewide Maternity and Neonatal Clinical Network (Queensland) Contact: Email: URL: Disclaimer This guideline is intended as a guide and provided for information purposes only. The information has been prepared using a multidisciplinary approach with reference to the best information and evidence available at the time of preparation. No assurance is given that the information is entirely complete, current, or accurate in every respect.

3 The guideline is not a substitute for clinical judgement, knowledge and expertise, or medical advice. Variation from the guideline, taking into account individual circumstances, may be appropriate. This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for: Providing care within the context of locally available resources, expertise, and scope of practice Supporting consumer rights and informed decision making, including the right to decline intervention or ongoing management Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion.

4 This includes the use of interpreter services where necessary Ensuring informed consent is obtained prior to delivering care Meeting all legislative requirements and professional standards Applying standard precautions, and additional precautions as necessary, when delivering care Documenting all care in accordance with mandatory and local requirements Queensland Health disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable.

5 Recommended citation: Queensland Clinical Guidelines Maternity care for mothers and babies during the COVID -19 pandemic. Guideline No. Queensland Health. 2021. Available from: State of Queensland (Queensland Health) 2022 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International licence. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Clinical Guidelines, Queensland Health and abide by the licence terms. You may not alter or adapt the work in any way. To view a copy of this licence, visit For further information, contact Queensland Clinical Guidelines, RBWH Post Office, Herston Qld 4029, email For permissions beyond the scope of this licence, contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email Cultural acknowledgement We acknowledge the Traditional Custodians of the land on which we work and pay our respect to the Aboriginal and Torres Strait Islander Elders past, present and emerging.

6 Queensland Clinical Guideline: Maternity care for mothers and babies during the COVID -19 pandemic Refer to online version, destroy printed copies after use Page 3 of 33 Flowchart: care of SCOVID or COVID -19 peripartum woman RAT: rapid antigen test, SCOVID: suspected COVID -19 positive, SpO2: peripheral capillary oxygen saturation Flowchart: Advise to return home using personal transport (not public transport or ride sharing options)Ongoing antenatal care Arrange alternate mode of antenatal care ( telehealth) if care cannot be delayed Resume usual antenatal care after release from self-quarantine or self-isolation Advise to telephone Maternity service if concernedCOVID-19 Provide advice about.

7 O Standard hygiene precautionso COVID -19 signs/symptoms/ management ( fact sheet)o Emergency contact informationo Isolation/quarantine precautions, requirements and testing and release processesVaccination and boosters Recommend vaccination (and booster) for family and close contacts (if not already vaccinated)Universal care and: Provide care in locations as per local facility protocols and according to clinical need Alert midwifery/obstetric/neonatal/infectious diseases/anaesthetic teams Limit visitors Symptomatic treatment as indicatedAntenatal Perform necessary medical imaging Fetal surveillance as clinically indicated Maternal surveillance and SpO2 Birth Negative pressure room (if possible) Mode of birth not influenced by COVID -19 unless urgent delivery indicated Lower threshold for escalation of clinical concernsCo-location of mother and baby Co-location recommended (if both well) Discuss risk/benefit with parents Determine need on individual basis Feeding (breastfeeding or formula)

8 Support maternal choice Breastfeeding recommended not contraindicatedRisk minimisation strategies Inform about hand hygiene, sneeze and coughing etiquette, face mask use, close contact, social/physical distancing and precautions during baby care , sterilisation Recommend vaccination (and booster) for family and close contacts (if not already vaccinated)Admission requiring COVID -19 precautionsSelf-isolation (SCOVID or COVID -19) Peripartum woman (+/- baby) with SCOVID or COVID -19 If returning to defined restricted area Follow Human Biosecurity and Local Council requirementsQuarantine or isolation Isolate a suspected/confirmed case Quarantine a close contact of a suspected/confirmed case Refer to criteria for releaseIn-patient hospital care indicated?

9 Perform clinical assessmentConsider RAT as per local protocolsNoYesQueensland Clinical Guideline: Maternity care for mothers and babies during the COVID -19 pandemic Refer to online version, destroy printed copies after use Page 4 of 33 Flowchart: Neonate of SCOVID or COVID -19 mother AGP: aerosol generating procedure, GP: general practitioner, ID: infectious diseases, NBST: newborn bloodspot screening test, PPE: personal protective equipment, SCOVID: suspected COVID -19 positive Flowchart: Baby born to SCOVID or COVID -19 mother (maternal COVID -19 is not itself an indication for neonatal unit admission) Neonatal unit admission required? Risk minimisation strategies for family Hand hygiene before and after contact Cough or sneeze into elbow Face mask during baby care Visitor restrictions Cleaning/sterilising equipment and surfaces Vaccination of eligible family membersNoYesAttendance at birth Neonatal team as per usual clinical indications Consider resuscitation in a room outside of birthing room/theatre (to minimise staff exposure)

10 Only essential equipment on resuscitaireo Store other equipment in accessible closed container that can be cleanedResuscitation Airborne and contact precautions All usual neonatal resuscitation procedures as indicatedPreparation for birthDischarge Prior to discharge, seek expert advice from Public Health Unit or ID physician Consider usual clinical criteria for discharge Provide advice about:o When to seek assistanceo Expected clinical courseo Follow-up for routine screening ( NBST) Notify community healthcare providers ( GP, child health services, health workers) of discharge and follow-up actions requiredIf quarantine to continue Advise family about requirements for quarantine at home Routine follow-up via telehealth/telephone until release from quarantineAfter care In isolation (if possible) Routine neonatal observationso Maintain awareness for symptoms of infection ( fever, tachypnoea) Support maternal feeding choice (including breastfeeding)


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