A Review on Mode of Delivery during COVID-19 between December 2019 and April 2020.

OBJECTIVE: This study aims to review the published literature to determine mode of delivery in pregnant women with coronavirus disease 2019 (COVID-19) and the indications reported for cesarean section early in the pandemic to add information to the current narrative and raise awareness of trends discovered. STUDY DESIGN: A systematic review was conducted by searching PubMed, Scopus, and ScienceDirect databases for articles published between December 2019 and April 29, 2020 using a combination of the keywords such as COVID-19, coronavirus 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pregnancy, vaginal delivery, cesarean section, vertical transmission, management, and guidelines. Peer-reviewed case studies with confirmed SARS-CoV-2 women who delivered were included to determine mode of delivery, indications for cesarean section, and maternal and neonatal characteristics. RESULTS: A review of 36 total articles revealed deliveries in 203 SARS-CoV-2 positive pregnant women. A comparable severity of disease in pregnant versus nonpregnant women was noted, as previously determined. Overall, 68.9% of women delivered via cesarean section, with COVID-19 status alone being a common indication. Maternal COVID-19 may also be associated with increased risk of preterm labor, although neonatal outcomes were generally favorable. Despite eight of 206 newborns testing positive for SARS-CoV-2, there remains no definitive evidence of vertical transmission. CONCLUSION: COVID-19 status alone became a common indication for cesarean delivery early in the pandemic, despite lack of evidence for vertical transmission. The increase in cesarean rate in this data may reflect obstetricians attempting to serve their patients in the best way possible given the current climate of constantly evolving guidelines on safest mode of delivery for the mother, infant, and provider. Upholding current recommendations from trusted organizations as new data are published, while also providing individualized support to expecting mothers on most appropriate mode of delivery, will reduce the amount of unnecessary, unplanned cesarean sections and could lessen the psychological impact of delivering during the COVID-19 pandemic. KEY POINTS: · COVID-19 may result in an increased rate of cesarean delivery for SARS-CoV-2 positive pregnant women.. · COVID-19 is a commonly reported indication for cesarean section, despite management guidelines urging against this.. · Although eight neonates tested positive for SARS-CoV-2, all additional fluid and tissue samples tested negative..

First Into the Lifeboats: Protecting Medical Student Education During the Hahnemann University Hospital Closure.

The announcement of the closure of Philadelphia's Hahnemann University Hospital in June 2019 sent shock waves through the academic community. The closure had a devastating impact on the residents and fellows who trained there, the patients who had long received their care there, and faculty and staff who had provided care there for decades. Since its beginnings, the hospital, established as part of Hahnemann Medical College in 1885, was a major site for medical student education. The authors share the planning before and actions during the crisis that protected the educational experiences of third- and fourth-year medical students at Drexel University College of Medicine assigned to Hahnemann University Hospital. The lessons they learned can be helpful to leadership in academic health systems in the United States facing a diminishing number of clinical training sites for medical and other health professions students, a situation that is likely to worsen as the COVID-19 pandemic continues to weaken the health care ecosystem.

Transdisciplinary simulation: learning and practicing together.

The Institute of Medicine, partnering with national private foundations, has challenged existing approaches to health care delivery and patient safety by suggesting a sweeping redesign of the entire U.S. health care system. This article explores the historical and philosophic imperative to change health care education to a seamless transdisciplinary model to foster interprofessional communication and collaboration during the formative training years. To improve patient safety and quality of care and reduce medical error, students in health care disciplines will need to be educated together to practice together effectively.