A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.

1. COVID-19 IN PREGNANCY
Helen V. Madamba, MD MPH-TM DHPEd FPOGS FPIDSOG
Chief Implementer, VSMMC COVID-19 Health Facility
18 August 2020

2. HVMADAMBA2020

3. HVMADAMBA2020

4. HVMADAMBA2020

5. HVMADAMBA2020

6. HVMADAMBA2020

7. 222 (67.3%)
died <48 hours
from
admission,
reflecting delay
in patient
consult for
symptoms.
HVMADAMBA2020

8. HVMADAMBA2020

9. SUSPECT
• Acute respiratory
tract infection
• Close contact with
COVID-19 case
• Absence of
alternative diagnosis
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
PROBABLE
• Suspect case
• Inconclusive
laboratory result
CONFIRMED
• With laboratory
confirmation of virus
causing COVID-19
infection
HVMADAMBA2020

10. CLOSE CONTACT
•direct physical
contact with a
COVID-19 case
•for 15 minutes
•within 2 meter
distance
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

11. Common Clinical Features of COVID-19
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

12. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

13. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

14. Sethuraman, et al.
HVMADAMBA2020

15. Recommendation Actions based
on Rapid Antibody Test
Symptom IgM IgG Recommended Action
(-) (-) (-) Adhere to quarantine protocols implemented in
the area
(-) (+) (-) Isolate for 14 days then repeat; if HCW, swab for
RT-PCR
(-) (+) (+) Considered recovered, no RT-PCR testing needed
(-) (-) (+) Considered recovered, no RT PCR testing needed
(+) regardless regardless
Isolate and swab
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

16. Clinical Significance of IgM/IgG Serological Test
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

17. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

18. CXR, Chest CT and lung ultrasound
•Not recommended as screening tool in
asymptomatic to mild cases.
•The most common features include lobar, multi-
lobar, or bilateral lung consolidation
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

19. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

20. Ground glass opacities
GGO, smooth and
irregular interlobular
septal thickening,
crazy paving pattern,
air bronchogram and
irregular pleural
thickening
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

21. MANAGEMENT OF PREGNANT PATIENTS WITH COVID-19
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
Thrombosis UK. Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected
with COVID-19. 2020 [Available from: https:// thrombosisuk.org/covid-19- thrombosis.php] accessed 07 April 2020
HVMADAMBA2020

22. Donders F, Lonnée-Hoffmann R, Tsiakalos A, Mendling W, Martinez de Oliveira J, Judlin P, Xue F, Donders GGG, ISIDOG Covid-Guideline Workgroup. ISIDOG
Recommendations Concerning COVID-19 and Pregnancy, Diagnostics (Basel). 2020;10(4) Epub 2020 Apr 22.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

23. Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus
Infections and Pregnancy Outcomes. Arch Pathol Lab Med 2020
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

24. American College of Obstetricians and Gynecologists (ACOG) COVID-19 FAQs for Obstetrical care on ObG Project COVID-19: Pregnancy Guidelines. and ACOG
Guidelines on Uptodate at https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-pregnancy-issues
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

25. Chen D, Yang H, Cao Y, Cheng W, Duan T, Fan C, Fan S, Feng L, Gao Y, He F, He J, Hu Y, Jiang Y, Li Y, Li J, Li X, Li X, Lin K, Liu C, Liu J, Liu X, Pan X, Pang Q, Pu M, Qi H, Shi C,
Sun Y, Sun J, Wang X, Wang Y, Wang Z, Wang Z, Wang C, Wu S, Xin H, Yan J, Zhao Y, Zheng J, Zhou Y, Zou L, Zeng Y, Zhang Y, Guan X. Expert consensus for managing
pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet. 2020;149(2):130. Epub
2020 Apr 1.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

26. Indications for Delivery with
Severe COVID-19 Infection
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

27. Berghella Vincenzo. Coronavirus disease 2019 (COVID-19): Pregnancy issues. Uptodate May 8, 2020
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

28. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance 13 March 2020.
https://www.who.int/publications-detail/clinical-management-of-severeacute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected (Accessed on April 10, 2020).
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

29. Intubation and extubation during general anesthesia are
considered aerosol generating procedures which may
contribute to spread of the virus and should therefore be
avoided in COVID-19 pregnant patients.
Royal College of Obstetrics and Gynecology (RCOG) Coronavirus (COVID-19) Infection in Pregnancy: information for Healthcare Professionals Version 8
[Internet]. 2020 April 17 available from https://www.rcog.org.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

30. American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), Pregnancy and Breastfeeding. https://www.acog.org/ (Accessed on March 25, 2020).
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

31. Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Statement on Coronavirus 2019 (COVID-19). March 10, 2020.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

32. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

33. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

34. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

35. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

36. PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
HVMADAMBA2020

37. INVESTIGATIONAL DRUGS USED IN COVID-19
• AZITHROMYCIN
• OSELTAMIVIR
• REMDESIVIR
• LOPINAVIR/RITONAVIR
• FAVIPIRAVIR
• TOCILIZUMAB
• RIBAVIRIN
• INTERFERON
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
• CORTICOSTEROIDS
• IMMUNOGLOBULIN
• ASCORBIC ACID
• MELATONIN
• ZINC
• CHLOROQUINE
• HYDROCHLOROQUINE
HVMADAMBA2020

38. IN VSMMC
Of 1,129 pregnant
patients admitted
under the COVID-19
team from March 20,
2020 to August 16,
2020, 196 (17.36%)
tested confirmed
COVID-19 positive.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
192
933
COVID STATUS
POSITIVE NEGATIVE
HVMADAMBA2020

39. IN VSMMC
Of 196 pregnant
patients that
tested confirmed
COVID-19
positive, 94.38%
were
asymptomatic.
PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
11
181
SYMPTOMATOLOGY
WITH SYMPTOMS ASYMPTOMATIC
HVMADAMBA2020

40. WARD 11 WARD 3A
ANNEX A
ANNEX B
WARD 3B
OBGYN
RENAL
UNIT
WARD 10
EREID NORTH
DISTRICT
SURGERY
HOLDING
AREA
WARD
9
WARD
8
ER
PHIC WARDWARD 7
CFI
WARD 4B
ARI
CLINIC
MAIN OR
OPD
SURGERY
PAVILION
PINK CENTER
CHILD
SURVIVAL
WARD 1 & 2
HVMADAMBA2020

41. VSMMC TRIAGE TO COVID-19 TEAM
(+) history of fever or respiratory
symptoms
(+) history of exposure/contact with
COVID-19
(+) geographic origin from an area with
evidence of sustained local transmission
HVMADAMBA2020

42. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City
HVMADAMBA2020

43. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City
HVMADAMBA2020

44. OBGYN ILI UNIT - OBAS
HVMADAMBA2020

45. OBGYN ILI UNIT – LABOR ROOM
LR/DR:
Positive Beds 4
Suspect 7
Isolation Bed 1
HVMADAMBA2020

46. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City
HVMADAMBA2020

47. OBGYN ILI UNIT - OBOR
OB/OR:
2 OR OPEN 24/7
for Emergency CS
HVMADAMBA2020

48. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City
HVMADAMBA2020

49. OBGYN ILI UNIT – ISOLATION ROOMS
OB/OR:
2 OR OPEN 24/7
for Emergency CS
3rd floor:
Isolation Rooms
HVMADAMBA2020

50. er
gy
Vicente Sotto Memorial Medical Center
Department of Obstetrics and Gynecology
B. Rodriquez Street, Cebu City

51. WARD 6 ANNEX A
HVMADAMBA2020

52. WARD 6 ANNEX A

53. COVID-19 IN PREGNANCY