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.