Elective and Medical Inductions, COVID Pre-testing, PPE in L&D, COVID Retesting

• Here is an updated elective and medical induction schedule. We are going to try and bring cervical ripening inductions in at night so that we can start Pitocin during the day. The goal is to become more efficient so that we can accommodate more inductions.
  
  
• We are continuing with 39 week pretesting with the caveat that if you think the patient will deliver prior to 39 weeks, or after 40 weeks, you should get them tested before or after. Guidelines are here.
  
  
• PPE recommendations on L&D. We are using airborne precautions if a patient is COVID-unknown or has a test pending when in the 2^nd stage of labor, or during CS since we now have CAPRs on the unit and more of our staff have been getting N95 fit tested.

• Covid re-testing. UW is testing their antepartum patients every week (and we have adopted this protocol as well), but this is NOT based on any actual data. Dr. Mike Hori with Infectious Disease has shared some interesting information from our South King County statistics,"Given the prevalence of COVID at any time based on RT PCR in the past 2 months is about .5% (serology may be higher because of minimal/asymptomatic disease) in South King County, I think the likelihood that someone would get COVID between 39 weeks and delivery would be low, particularly if they are avoiding social contact and I would not test again unless a new exposure or symptoms." Given his read of this information as well as what UW is doing, we are offering re-testing to patients if their COVID-19 screen is more than one week old. Here is the information that will be placed in triage to inform when to re-test patients.