Protecting Labor and Delivery Personnel from COVID-19 during the Second Stage of LaborFunding J.J.M. is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K08HL150340. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
28 March 2020
30 March 2020
10 April 2020 (online)
The novel coronavirus disease 2019 (COVID-19) is spreading fast and is affecting the clinical workers at much higher risk than the general population. Little is known about COVID-19 effect on pregnant women; however, the emerging evidence suggests they may be at high risk of asymptomatic disease. In light of projected shortage of personal protective equipment (PPE), there is an aggressive attempt at conservation. In obstetrics, the guidelines on PPE use are controversial and differ among hospitals, globally, as well as nationally. The centers for disease control and prevention (CDC) recommend using N95 respirators, which are respirators that offer a higher level of protection instead of a facemask for when performing or present for an aerosol-generating procedures (AGP). However, the second stage of labor is not considered an AGP. The second stage of labor can last up to 4 hours. During that time, labor and delivery personnel is in close contact to patients, who are exerting extreme effort during and frequently blow out their breath, cough, shout, and vomit, all of which put the health care team at risk, considering that COVID-19 transmission occurs through aerosol generated by coughing and sneezing. The CDC and the American College of Obstetricians and Gynecologists (ACOG) do not provide clarification on the use of N95 during the second stage. We recommend that labor and delivery personnel have the utmost caution and be granted the protection they need to protect themselves and other patients. This includes providing labor and delivery personnel full PPE including N95 for the second stage of labor. This is critical to ensure the adequate protection for health care workers and to prevent spread to other health care workers and patients.
Second stage of labor exposes providers to aerosol.
COVID-19 risk during second stage of labor is high.
N95 should be used during second stage of labor.
- 1 Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7 (04) e35797
- 2 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
- 3 Zayas G, Chiang MC, Wong E. , et al. Cough aerosol in healthy participants: fundamental knowledge to optimize droplet-spread infectious respiratory disease management. BMC Pulm Med 2012; 12: 11
- 4 van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One 2008; 3 (07) e2618
- 5 van Doremalen N, Bushmaker T, Morris DH. , et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020
- 6 Liu Y, Ning Z, Chen Y. , et al. Aerodynamic characteristics and RNA concentration of SARS-CoV-2 aerosol in Wuhan hospitals during COVID-19 outbreak. bioRxiv 2020; DOI: 10.1101/2020.03.08.982637.
- 7 Breslin N, Baptiste C, Milelr R. , et al. COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol MFM 2020 (In Press). Doi: 10.1016/j.ajogmf.2020.100111