Outcomes of Late-Preterm and Term Infants Born to SARS-CoV-2-Positive Mothers

With the spread of coronavirus disease 2019 (COVID-19) in Korea, the number of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly increasing. A shortage of negative-pressure isolation rooms for newborns makes hospital assignment more difficult for late-pregnant women with COVID-19. Among 34 infants born to SARS-CoV-2-positive mothers, 5 (14.7%) presented with respiratory distress and 1 (2.9%) presented with feeding intolerance that required specialized care. Aerosolgenerating procedures were performed in one infant. Overall outcomes of 34 infants were favorable, and no infant tested positive for SARS-CoV-2. Most infants born to SARS-CoV-2-positive mothers did not need to be quarantined in a negative-pressure isolation room, and 17 (50%) mother–infant dyads were eligible for rooming-in. If negative-pressure isolation rooms are selectively used for newborns requiring aerosol-generating procedures or newborns in respiratory distress, resource availability for lower-risk cases may improve.

Height of elevated fetal buttock for prediction of successful external cephalic version

14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57–74.94), 5.26 (95% CI, 1.06–26.19), and 10.50 (95% CI, 1.03–107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54–0.78), 0.74 (95% CI, 0.64–0.85), and 0.69 (95% CI, 0.62–0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm.CONCLUSION: This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Establishing an Emergency Maternal Transport Control Center

The total fertility rate in South Korea is one of the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. However, the number of advanced maternal age and high risk pregnancies are rising due to delays in marriage and increased infertility rates, resulting in a maternal mortality rate that is higher than the OECD average. The most common cause of maternal mortality has been reported to be obstetric embolism, followed by postpartum hemorrhage. Hemorrhage is a preventable condition that can be solved by expeditious initial management such as transfusion, medication, and prompt transfers to tertiary centers that are capable of managing obstetric emergencies. However, the number of maternity care hospitals in underserved areas has been falling since 2004 due to business losses stemming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. The insufficient maternity care system for high risk pregnant women in Korea has also led to an increase in maternal mortality. Therefore, the Ministry of Health and Welfare has supported the establishment of an ‘Integrated Care Center for High Risk Pregnancy and Neonate’ for high risk maternity and neonatal cases. However, there is no systematic transfer system in place to monitor and support emergency patient transfers in the event of obstetric emergencies. Although the Disaster & Emergency Medical Operations Center is currently carrying out these tasks, it is insufficient to properly manage all obstetric transfers. Our plan is to establish an Emergency Maternal Transport Control Center that is linked with the existing Disaster & Emergency Medical Operations Center at the National Medical Center. To implement this system, cooperation from each maternity and neonatal center will be crucial to share available human and material resources. Successful implementation of this system will allow for communication not only with the regional perinatal centers, but on a nationwide scale to detect and conduct necessary transfers of high risk pregnancy patients in emergency situations. It is anticipated that this system will significantly improve maternal health care as well as obstetric infrastructure, especially in underserved areas.