‘A life is given in the midst of tragic deaths in COVID’

If the COVID-19 pandemic emerged as uncharted territory, so has managing the prenatal care and delivery of the COVID-positive patient.

Kristina Salcedo, director of women and infant services at Silver Cross Hospital in New Lenox said she did weekly calls with other Illinois hospitals through the Illinois Perinatal Quality Collaborative to share information and brainstorm.

“It was a great bonding and learning time together,” Salcedo said.

Right from the start, staff wore N95 masks when delivering babies for women who were COVID-19-positive. Initially, these mothers were separated from their babies after birth. Later, they were given a choice, Salcedo said.

If mothers were nursing, they could pump their milk, which was given to their babies, or they could wear face masks while breastfeeding, she said.

But COVID-19 itself did not stop babies from coming. Salcedo said Silver Cross, which delivers “the most babies in Will County” saw a “record number” of births for 2020: 2,998, she said.

How many of those babies tested positive for COVID-19?

“None,” Salcedo said.

Debra Robbins, director of marketing and communications at Silver Cross, said patient satisfaction in women and infant services was above the 95th percentile.

‘We did not have blood clots, we did not have strokes’

Perhaps the biggest change in prenatal care in the beginning of the pandemic was that dads and older children couldn’t come to the prenatal appointments; the moms had to come alone, said Dr. Nicole Gress, an obstetrician who delivers patients at Silver Cross.

COVID-19-positive moms were separated from other pregnant women in the office and seen toward the end of that day, Gress said.

Women were not routinely tested for COVID-19 until labor, she said. And regardless of COVID-19 status, they were allowed one support person in the room with them at all times.

However, if the mom was COVID-19-positive, both parents were confined to the room until discharge, she said.

Gress stressed that, especially in the beginning, no one had a “textbook way” to manage pregnant women who were COVID-19-positive.

“There wasn’t a lot of guidance on what we should do,” Gress said.

For instance, Gress put her COVID-19-positive patients on low-dose aspirin (81 mg) for the remainder of the pregnancy to prevent blood clots to the placenta, but she said other providers did not use that same therapy.

It didn’t matter if the woman was eight weeks pregnant or 28 weeks pregnant. If she was COVID-19-positive and Gress’ patient, she received aspirin therapy for the remainder of her pregnancy, Gress said.

The American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine already recommends low-dose aspirin (81 mg) for women at high risk of preeclampsia, which the woman take daily until delivery.

“We knew it was safe and we knew its benefits with certain populations,” Gress said.

Gress feels the low-dose aspirin did what it was supposed to do.

“We did not have blood clots, we did not have strokes and we did not have any fetal loss in any of our COVID-positive patients,” Gress said.

But Gress did see more complications in her COVID-19-positive patients than she did in her patients who did not test positive.

The risk of complications was not related to disease severity. In fact, Gress said all of her COVID-19-positive patients only had mild illness. But Gress still saw more complications in those patients, even weeks later, after they recovered.

Complications included preeclampsia and uncontrolled diabetes in the mother and growth restriction in the fetus, she said.

‘It just lightened up the mood to know a baby was born’

Dr. Thomas Kazmierczak, an obstetrician who delivers patients at Silver Cross Hospital, said he has treated 25 COVID-19-positive pregnant patients, and all of them were referred to a maternal-fetal medical specialist for at least part of their pregnancies.

He kept COVID-19-positive patients in his office separate from patients who did not have the virus by assigning them to either a red zone (positive) or a green zone (negative).

Instead of low-dose aspirin, Kazmierczak’s COVID-19-positive patients received the anticoagulant drug Lovenox (enoxaparin). Patients also received an ultrasound at 32 weeks to check fetal growth.

“It worked out great,” Kazmierczak said.

COVID-19, overall, did not impact the actual delivery of the fetus. The goal always was to deliver vaginally when medically possible, and Silver Cross Hospital always had plenty of personal protective equipment, which Kazmierczak attributed to hospital CEO Ruth Colby’s quick thinking at the beginning of the pandemic.

“That increased our morale,” Kazmierczak said. “It made for a pleasant birth experience in the midst of the pandemic for a lot of moms and families.”

Kazmierczak said that with all the terror of COVID-19 and its deadly repercussions, one thing always topped it.

“Every time we heard Brahms’ Lullaby, it just lightened up the mood to know a baby was born, that a life is given in the midst of tragic deaths in COVID,” Kazmierczak said.