Updated: April 30, 2021

Pregnant women who have known or suspected COVID-19 infection need to be evaluated quickly to determine the severity of their symptoms and if they have risk factors that put them at risk for severe disease. New data on the outcomes for pregnant women have shown that pregnancy is a risk factor for increased severe mortality and morbidity; for example, respiratory distress requiring intubation and admission to ICU, maternal death, and obstetric complications such as preterm birth and stillbirth (Jama Intern Med 2021).

Seven percent of pregnant women who underwent testing for COVID-19 were found to be positive, with 75%-85% asymptomatic and 90% stable enough to be treated outpatient. Thus, most women diagnosed with this infection can be treated without hospitalization, but all known or suspected infected patients must be closely monitored.

In January 2020, the first case of the novel virus known as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), responsible for COVID-19 disease, was found in the United States. Since that time, there have been 6 major vaccines developed to prevent infection with this virus. However, none of the original trials included pregnant women. Three of these vaccines – Moderna, BioNTech-Pfizer and Johnson & Johnson have received Emergency Use Authorization (EUA) for administration in the U.S. population, with 100 million doses given as of this article’s writing. Soon after the EUA was determined, the CDC, ACOG and SMFM released recommendations specific for pregnant women:

• COVID-19 vaccines should not be withheld from pregnant women.
• Counseling is not required, and more importantly, lack of counseling should not deter a woman from becoming vaccinated. (ACOG Practice Bulletin, March 4, 2021)

[10 MIN READ]

Updated: August 20, 2020

Navigating the ever-changing landscape surrounding the coronavirus pandemic is keeping everyone on their toes. Healthcare administrators and provider inboxes are packed with notifications and updates. We are all trying to sort through what is pertinent to hands-on patient care while doing our due diligence to remain up to date and well informed.

Early pandemic guidelines were based on expert opinion with little evidence to support recommendations. As the pandemic wears on and high-quality evidence becomes available, new recommendations will evolve supporting standardization of practice. While keeping current can seem daunting, it remains crucial for the safety of both you and your patients that you continue to do your best to remain knowledgeable and informed. The Centers for Disease Control (CDC) and the American College o Obstetricians and Gynecologists (ACOG) offer ongoing updates; patient handouts are available on these sites as well.

Provided here is a brief synopsis of newer updates (July/August 2020) specific to COVID and the obstetric population.

[9 MIN READ]

Updated: March 18, 2020

Working on the front lines of an obstetric unit is fraught with vulnerability and uncertainty during these early stages of the unprecedented COVID-19 pandemic. Your obstetric team has never before been so codependent in maintaining safety for you and your entire community. Arming yourself and teammates with the most current knowledge will help to keep you, your family, and your patients as safe as possible.

Since much is unknown about the novel coronavirus, review of daily updates and evolving information from our health experts is important. Staying knowledgeable and well-informed will require ongoing review of CDC updates and government notifications, as well as guidelines from our own health professionals like AWHONN and ACOG. All healthcare providers and frontline OB staff should work together to help ensure that everyone is practicing using the most current information. Teamwork along with shared learning will help everyone stay informed.

To keep yourself and your obstetric peers current on COVID-19, The Sullivan Group is providing this summary of recent information from the CDC and ACOG (last updated March 18, 2020).

[7 MIN READ]

As heightened U.S. maternal morbidity and mortality rates gain national attention, AWHONN and ACOG, as well as state perinatal quality collaboratives, notably California, have emphasized that hospitals need to focus on improving outcomes with specific attention to the leading causes of maternal mortality.

The RSQ® Assessment – Obstetrics provides the framework for the creation of a comprehensive obstetrics safety program within your organization, as well as the foundation for an obstetric culture of safety surrounding the key drivers of maternal mortality and morbidity.

[9 MIN READ]

Standardization is known for reducing variation and increasing consistency; it continues to be a recognized safeguard to decreasing liability and improving outcomes.

High-quality postpartum care includes implementation of both standardized discharge processes and teaching that can improve maternal outcomes.

AWHONN promotes postpartum discharge standardization and encourages that specific components of postpartum discharge teaching align with leading causes of maternal morbidity and mortality.

While we previously outlined best practices in postpartum discharge teaching strategies, here we will discuss specific standardized teaching content that needs to be communicated to postpartum patients and their families at the time of discharge or sooner.

Educating patients and their families to recognize important warning signs and symptoms and clearly understand normal healing versus abnormal symptomatology is strategic in reducing maternal morbidity and mortality.

[2 MIN READ]

Designing a continuing education program for your obstetrics department can be a challenging task. You want to balance the needs of all clinicians on your unit, address areas of concern, and keep pace with the ever-changing landscape of evidence-based practice and emerging national guidelines and trends. TSG’s RSQ® Solutions – Obstetrics Education program can meet your needs; our online library offers you the ability to customize your own program specific to the challenges of your own OB unit.

[4 MIN READ]

ACOG has issued a practice advisory regarding the recent measles outbreak.

It is hard to fathom that a disease once considered eradicated is now in a state of progression across the United States. To date, there are 764 reported cases across 23 states; this number has increased by 60 cases from the previous week as reported by the CDC. No state is immune, and nationwide advancement is probable.

[8 MIN READ]

Unprecedented maternal mortality and morbidity rates nationwide have pushed healthcare providers and obstetric experts to closely examine all areas of perinatal and obstetric health. Specifically, the postpartum period is a time of heightened patient vulnerability and is fraught with maternal risk. Sixty-one percent of pregnancy-related deaths occur in the postpartum period, making it potentially more hazardous to a woman’s health than the actual pregnancy itself.

[6 MIN READ]

After reading the case with perspective on how to recognize secondary postpartum hemorrhage, it's critical to understand why it occurs and how to treat it.

Etiology of Secondary PPH

Why does secondary PPH occur? The normal physiologic changes associated with pregnancy are the perfect predisposition for an unrecognized hemorrhage. Typically, pregnant women are young and healthy with increases in circulating blood volume and hormonal and vascular changes specific to pregnancy. All of this creates the perfect environment for hemorrhage.