Preparation and consideration for establishment of an isolation maternity unit in a tertiary hospital during COVID-19 pandemic.

The SARS-CoV-2 pandemic is rapidly evolving and remains a major health challenge worldwide. With an increase in pregnant women with COVID-19 infection, we recognized an urgent need to set up a multidisciplinary taskforce to provide safe and holistic care for this group of women. In this review of practice in a tertiary hospital in Singapore, we discuss the key considerations in setting up an isolation maternity unit and our strategies for peripartum and postpartum care. Through teleconsultation, we involve these women and their families in the discussion of timing and mode of birth, disposition of babies after birth and safety of breastfeeding to enable them to make informed decisions and individualize their care.

An Unusual Case of Cerebral Arteriovenous Malformation in Pregnancy.

We present a case of a woman at 31 weeks and 3 days of gestation, who developed a sudden and severe headache and loss of vision in her left eye. Magnetic resonance imaging (MRI) of the brain revealed a subarachnoid bleed secondary to a right parieto-occipital arteriovenous malformation (AVM). She was conservatively managed and subsequently transferred to our institution for multidisciplinary care. The patient underwent a cesarean section at 34 weeks and 5 days of gestation followed by gamma knife surgery 6 days after. Cerebral AVMs, although relatively rare, have the propensity to cause potentially fatal outcomes. Neurological symptoms in a pregnant woman warrant investigations for early diagnosis and management, due to its associated morbidity and mortality. The management of cerebral AVMs in pregnancy is decided after weighing the benefits of treatment against the risk of bleeding. A multidisciplinary approach should be adopted due to the complexity of the condition.

Varying clinical presentations of umbilical venous catheter extravasation: A case series.

Umbilical venous catheter insertion is a common procedure in the neonatal units performed for rapid vascular access. Though relatively safe and easy to perform, suboptimal position of the catheter tip is frequently encountered and can lead to wide range of complications from venous thrombosis, catheter extravasation with extravasation of infusate to intraperitoneal or intrapericardial space, liver injury and cardiac arrhythmias. Identification of catheter extravasation may be difficult and often confused with catheter related infection or necrotising enterocolitis. We present a series of three cases of intraperitoneal extravasation of umbilical venous catheter in the premature neonate with widely varying presentation from subtle biochemical changes to critical clinical signs with rapid and progressive deterioration.

Use of web-based game in neonatal resuscitation - is it effective?

BACKGROUND: Knowledge and skills decline within months post simulation-based training in neonatal resuscitation. To empower 'Millennial' learners to take control of their own learning, a single-player, unguided web-based Neonatal Resuscitation Game was designed. The present study investigates the effectiveness of the game on retention of resuscitation knowledge and skills. METHODS: The study evaluated 162 healthcare professionals who attended simulation-based training in neonatal resuscitation. Following standard simulation-based training, participants were assigned to either a gaming group (Gamers) with access to the web-based Neonatal Resuscitation Game or a control group (Controls) with no access to the game. Although Gamers were given access, game utilization was completely voluntary and at will. Some Gamers chose to utilize the web-based game (Players) and others did not (Non-players). Knowledge and skills in neonatal resuscitation were assessed upon completion of training and 6 months post-training using a multiple-choice question test and a manikin-based skills test. Changes in scores were compared statistically between Gamers vs Controls, Players vs Controls, and Players vs Controls + Non-players using two-sample t-tests. RESULTS: At the final assessment, declines in knowledge scores were seen in all groups. Mean change from baseline in knowledge and skill performance scores at 6 months, adjusted for baseline skill performance and MCQ test scores, did not differ significantly between Players vs Controls and Players vs Controls + Non-players. CONCLUSION: The web-based game in its current format may not be effective in facilitating retention of knowledge and technical skills in neonatal resuscitation.