key: cord-0782665-p7iqzpaa authors: Ferrazzi, Enrico M.; Frigerio, Luigi; Cetin, Irene; Vergani, Patrizia; Spinillo, Arsenio; Prefumo, Federico; Pellegrini, Edda; Gargantini, Gianluigi title: COVID‐19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and short report of outcome date: 2020-05-18 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13162 sha: 19afc56fbbaa0585a4fb858f63e37dac851f8e9f doc_id: 782665 cord_uid: p7iqzpaa From February 24, 2020, a COVID‐19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID‐19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high‐risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre‐triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre‐triage screening and surgical masks for personnel and patients for pre‐triage‐negative patients. Forty‐two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred. transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred. COVID-19; pregnancy; SARS-CoV-2 The Regional Health Authority of Lombardy, Italy, instructed the The media played a key role in helping to disseminate the information surrounding the lockdown restrictions. (5) All connecting network hospitals (n=50) should be able to organize a protected vaginal or cesarean delivery for a woman in advanced labor who cannot be transferred. This means appropriate PPE must be available, and one dedicated labor and delivery or operating room must be made available for this emergency situation. The first interim analysis was carried out during the period March 1-20, 2020, deriving data from a dedicated database shared by all maternity hubs and summarized in the present article. A total of 42 pregnant women with confirmed COVID-19 delivered during this time period. 2 These cases represent approximately 0.6% of the expected 7000 deliveries in the same region over the same time period. The clinical presentation was interstitial pneumonia in 20 (48%) women; 7 (35%) of these required continuous positive airway pressure (cPAP) or were admitted to the ICU. All did well to recover in a shorter period of time compared with the typical 10-15 days required to overcome the critical phase of SARS-CoV-2 pneumonia. A total of 18 (43%) women were delivered by cesarean, and 24 (57%) delivered vaginally. Only two patients had a spontaneous premature delivery. Since this report was collected a few more cases requiring major respiratory support have been recorded by COVID-19 hubs, presenting with dyspnea that required immediate treatment, both during pregnancy and postpartum. These few but critical cases underline the benefits of the policy of centralization, as patients were transferred to the designated maternity hubs. On the other hand, in women who develop COVID-19 during pregnancy, the symptoms tend to be mild or moderate, 3 possibly as a result of the combined effects of gender, young age, and immune status of pregnancy; this suggests that, in an area of high prevalence of infection, more women may be positive but asymptomatic. Therefore, the rules of protection for healthcare providers working in labor and delivery have been updated to cover ALL laboring women: • During labor the midwife and laboring woman wear surgical masks. • During the second stage of labor the midwife wears appropriate PPE. • A woman's partner is permitted to attend during labor and delivery but is not permitted on the postpartum ward. Regarding breastfeeding: • ALL women breastfeed while wearing a surgical mask. • COVID-19-positive mothers with mild or no symptoms can breastfeed. • COVID-19-positive and symptomatic mothers are separated from their newborns, and women can use pumps to express breast milk. The OTF typically holds a video conference call every 15 days to discuss possible upgrading of the recommendations. EMF, IC, PV, EP, and GG contributed as members of the COVID-19 Obstetric Task Force. LF, EMF, IC, PV, AS and FP contributed to the interim analysis. GG and EP chaired the task force on behalf of the Regional Health Care Authority. We are grateful to all healthcare providers who worked with the best of their skills and dedicated care to mothers and their newborns both in the hubs and spokes of our region, which was the first to experience the brunt of this pandemic in Europe. The authors have no conflicts of interest. Offline: COVID-19 and the NHS-"a national scandal Mode of delivery and clinical findings in COVID-19-infected pregnant women in Northern Italy Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals