Donning the powered air-purifying respirator in an emergency obstetric setting amid the COVID-19 outbreak in Singapore: a balance between safety and urgency

摘要

As frontline staff working in the largest maternity unit in Singapore during the coronavirus disease 2019 (COVID-19) outbreak, we wish to raise awareness of the dilemma faced during emergency obstetric procedures that are time sensitive and crucial in determining obstetric and neonatal outcomes. During the COVID-19 outbreak, healthcare workers (HCWs) are required to don the powered air-purifying respirator (PAPR) as part of the personal protective equipment (PPE) when attending to suspected or confirmed COVID-19 patients during aerosol-generating procedures (AGPs), including labour and Caesarean sections. Multiple steps are required when donning the PPE and PAPR, which include turning on the air filter, checking its integrity, adjusting the waist belt and attaching the air filter to the belt, and finally wearing the hood over the head. The entire process takes a considerable amount of time depending on level of training and familiarity with the procedure. While this is a necessary step for the safety of HCWs during the outbreak to prevent disease transmission, in an obstetric setting, where immediate emergency Caesarean sections may be indicated for non-reassuring fetal heart tracings, placental abruption or cord prolapse, every minute of delay affects the prognosis of the mother and fetus. How can we then balance the safety of HCWs with this time urgency in emergency obstetric procedures?.