Medical assistance
From our clinical observation, postponement or cancelation of planned check-up or delivery has already led to recent negative consequences. To prevent irreversible adverse events, we believe that postponing prenatal care visit or delivery should not be applied to everyone. In some circumstances, instead, scheduled check-up and prompt hospitalization were highly recommended: (1) approaching terminal gestational age (beyond 37 completed weeks); (2) complex multiple pregnancy; (3) with severe maternal comorbidity or obstetrical complication; (4) signs of labor (rupture of membrane, severe abdominal pain, etc.); (5) Any of the following signs including abnormal fetal movement, vaginal bleeding, convulsions/fits, severe headaches with blurring vision, fever, severe abdominal pain, fast or difficult breathing.36 It is also suggested that some essential prenatal examinations should not be postponed beyond its opportune gestational age: (1) ultrasound examination for confirming intrauterine pregnancy and Nuchal Translucency (NT) measurement (11+0 to 13+6 weeks); (2) screening for fetal aneuploidy; (3) prenatal diagnosis with medical indications; (4) ultrasound screening for fetal structural anomalies; (5) oral glucose tolerance test (24+0 to 27+6 weeks). Notably, to avoid cross-infection, designated hospitals for COVID-19 treatment were assigned in all counties in China. Going to hospital, which is not on the list of treatment center, is still relatively safe but reasonable protective measures (wearing masks and hand hygiene) must be taken.
Our findings suggested that caesarean delivery on maternal request (CDMR) and bottle feeding might increase to avoid vertical transmission. For researchers, lessons about vertical transmission could be learnt from other similar PHEs (like SARS and MERS) 37-39, and as new evidence comes to light 13,14,40, such possibility is likely to be rejected. Recently, our group proposed a contingency plan for the 2019-nCoV outbreak in the Neonatal Intensive Care Units, where the possibility of vertical transmission was also discussed.41 However, more explorations with transparency and solidarity on the mother-to-child transmission are still needed.42 For obstetricians, the preparations for increasing caesarean rate and the contingency plan for perinatal infection need to be developed and implemented quickly. Importantly, the authoritative education on delivery and child-feeding during this special period should be available to prenatal mothers. Additionally, the education about the radiography during pregnancy should focus on its comparative safety and diagnostic necessity, to decrease patients’ concerns.
How to conduct education andconsultation:digital healthcare
In summary, online official media, such as WeChat or application programs, can provide authoritative prevention education and medical consultation updated every day. These means are essential in this period of time and will become a trend afterwards.8In our study, more than 70% of participants proposed that advice should be obtained in this way. First of all, booking medical time through online platform helps to avoid overcrowding. Secondly, it is relatively safe and convenient to keep in touch with doctors, especially in the case of a PHE. Thirdly, in the era of big data, under the premise of confidentiality, the research based on network platforms will be very meaningful. At present, our research team is focusing on the detailed medical problems put forward by pregnant women on the Internet. The results can be used to guide obstetric practice and develop into personalized medical and health education in the future.