Good practices for ultrasound examinations in gynecology and obstetrics during the COVID-19 pandemic

Fernando Maia Peixoto Filho Adriana Gualda Garrido Anselmo Verlangieri Carmo Eduardo Becker Júnior Guilherme de Castro Rezende Heron Werner Junior Joffre Amin Junior Jorge Roberto Di Tommaso Leão Luciano Marcondes Machado Nardozza Luiz Eduardo Machado Manoel Alfredo Curvelo Sarno Patricia El Beitune Pedro Pires Ferreira Neto Sergio Kobayashi Fabricio da Silva Costa About the authors

Key points

  • Routine ultrasound examinations by specialists are an essential part of prenatal care and should be performed even in the extraordinary situation of the COVID-19 pandemic.

  • The routine of obstetric and gynecological ultrasound services during COVID-19 pandemic period was changed to increase the protection of the patient, her fetus and her family, as well as of health professionals involved in care.

  • The impossibility of maintaining the recommended distance during the ultrasound examination requires rigorous and systematic precautions, because patients and health professionals are exposed to COVID-19 infection.

  • Given the risk of COVID-19 transmission, the performance of ultrasound examinations in gynecology and obstetrics must be based on a priority assessment and in accordance with Febrasgo protocols.

  • COVID-19 infection within health services must be avoided at all costs. Part of this strategy involves the surveillance of employees in the sector and the systematic use of personal protective equipment (PPE).

Recommendations

  • Obstetric and gynecological ultrasound services must prevent the scheduling of appointments in person.

  • Obstetric and gynecological ultrasound services should prepare informative material on infection prevention in the form of leaflets, use iconographic material in the various environments of the ultrasound sector and apply questionnaires about COVID-19 to patients to define the infection status.

  • Patients must undergo screening before entering an ultrasound unit in order to check if they are already infected or have any suspicion for COVID-19.

  • The ultrasound sector should provide information about specific training on hygiene, use of PPE and equipment handling for healthcare professionals, including doctors, nurses, technicians, cleaning, maintenance and administrative staff, among others.

  • Symptomatic patients not severely immunosuppressed: reschedule after ten days from the onset of symptoms.

  • Patients living with people with symptoms of COVID-19: reschedule after 14 days.

  • Positive polymerase chain reaction (PCR) patients who remain asymptomatic, not severely immunosuppressed: exempt from the scheduled appointment and reschedule ten days after the first positive real-time PCR (RT-PCR) test for COVID-19.

  • Patients with positive PCR who remain asymptomatic and severely immunosuppressed: exempt from the scheduled appointment and reschedule 20 days after the first positive RT-PCR test for COVID-19.

  • Aiming to reduce the time of direct contact with the patient, make videos of anatomical regions or capture specific screenshots and take biometric measurements offline. An experienced ultrasonographer may be chosen to perform the exams, thereby reducing the exam time and the need for a second opinion.

Background

The COVID-19 pandemic period changed the routine of obstetric and gynecological ultrasound services,11 Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Sutantawibul A, Chuchotirot M, Phattanachindakun B, et al. Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic. J Perinat Med. 2020;48(9):931-42. doi: 10.1515/jpm-2020-0228
https://doi.org/10.1515/jpm-2020-0228...
as well as the routine in all other women's health care services.22 American College of Obstetricians and Gynecologists (ACOG). Novel Coronavirus 2019 (COVID-19): Practice Advisory [Internet]. 2020 [cited 2020 Nov 12]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
https://www.acog.org/clinical/clinical-g...
33 International Federation of Gynecology and Obstetrics (FIGO). Safe motherhood and COVID-19 [Internet]. 2020 [cited 2020 Nov 12]. Available from: https://www.figo.org/safemotherhood- and-covid-19
https://www.figo.org/safemotherhood- and...
Such changes involve a series of protective measures that will be highlighted in this regulation.

Based on the care, safety and prevention of COVID-19, procedures to improve the protection of the patient, her fetus and her family and of health professionals involved in the care are mentioned. Routine ultrasound examinations by specialists are an essential part of prenatal care and should be performed even in the extraordinary situation of the COVID-19 pandemic. Precautions must be rigorous and systematic in the practice of this clinical activity, mainly because there is exposure of the patient and health professionals, given the impossibility of maintaining the recommended distance during the procedure.11 Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Sutantawibul A, Chuchotirot M, Phattanachindakun B, et al. Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic. J Perinat Med. 2020;48(9):931-42. doi: 10.1515/jpm-2020-0228
https://doi.org/10.1515/jpm-2020-0228...

The information found in this document is based on the best practices recommended by National and International Diagnostic Imaging Societies and guided by two main axes:

  1. Prevention against the expansion of COVID-19 during the performance of ultrasound examinations of women;

  2. Protection of the patient and health care professionals in the ultrasound sector in order to maintain a safe workflow from the scheduling to the performance of exams. Note that conducts provided here can be adapted depending on the availability of resources and infrastructure.

Routine of obstetric and gynecological ultrasound exams in the context of the COVID-19 pandemic

How should the scheduling of exams in gynecology and obstetrics be during the COVID-19 pandemic?

The guidelines to avoid scheduling in person are as follows:44 Colégio Brasileiro de Radiologia e Diagnóstico por Imagem. Recomendações gerais de prevenção de infecção pelo COVID-19 para clínicas e serviços hospitalares de diagnóstico por imagem [Internet]. 2020 [cited 2020 Jul 25]. Available from: https://cbr.org.br/recomendacoes-gerais-de-prevencao-deinfeccao- pelo-covid-19-para-clinicas-e-servicos-hospitalaresde- diagnostico-por-imagem/
https://cbr.org.br/recomendacoes-gerais-...
55 Poon LC, Abramowicz JS, Dall’Asta A, Sande R, Ter Haar G, Maršal K, et al. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol. 2020;55(5):709-72. doi: 10.1002/uog.22027
https://doi.org/10.1002/uog.22027...
66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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  • Exams must be scheduled by phone or the internet;

  • The professional of the service unit, previously guided by doctors, should contact the patient on the eve of the exam to check about symptoms and risk factors for COVID-19 (Chart 1);

  • Scheduling times should have a safe interval in between to avoid the crowding of patients in the waiting room;

  • If patients have already done tests before, they should be instructed to bring them;

  • If patients spontaneously appear at the medical ultrasound unit without prior appointment, they must return with a rescheduling and be informed that their prenatal care will not be affected;

  • In cases that a rescheduling is impossible, when these patients present some type of symptom, possibly related to a respiratory infection, such as cough, fever or sore throat, they must undergo screening immediately for guidance to the best solution.

Chart 1.
Guidelines for screening patients for coronavirus infection in elective exams.

In the screening of patients for elective exams, what is the procedure to avoid COVID-19 transmission?

Before entering an ultrasound unit to do their exams, patients must undergo screening in order to check if they are already infected or have any suspicion for COVID-19.

This screening should be done with all preventive care:

  • Mandatory use of masks;

  • Control of the entry, exit and transit of patients;

  • Reservation of a specific place in the waiting room;

  • Access to information on respiratory etiquette.

Informative material on the prevention of infection should be prepared in the form of leaflets, iconographic material should be used in the various environments of the ultrasound sector and questionnaires about COVID-19 should be applied to patients to define the infection status.

Patients should be investigated for symptoms related to the risk of COVID-19 (Chart 1).77 Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas e Estratégicas. Manual de recomendações para a assistência à gestante e puérpera frente à pandemia de Covid-19 [Internet]. Brasília (DF): Ministério da Saúde; 2020 [cited 2020 Nov 25]. Available from:http://189.28.128.100/dab/docs/portaldab/documentos/corona/manual_recomendacoes_gestantes_covid19.pdf
http://189.28.128.100/dab/docs/portaldab...
At this time, their temperature should be measured. In case of cough, high fever or shortness of breath, these patients must undergo specific screening for COVID-19 and evaluation by a health professional in accordance with local protocols.66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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What are the recommendations for screening patients with possible coronavirus infection in elective exams?

  • Symptomatic patients not severely immunosuppressed: reschedule after ten days from the onset of symptoms.88 Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/Anvisa No. 07/2020. Orientações para prevenção e vigilância epidemiológica das infecções por SARS-CoV-2 (COVID-19) dentro dos serviços de saúde. (Complementar à nota técnica GVIMS/GGTES/ANVISA No. 04/2020) [Internet]. 2020 [cited 2020 Dec 5]. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
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  • Patients living with people with symptoms of COVID-19: reschedule after 14 days.88 Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/Anvisa No. 07/2020. Orientações para prevenção e vigilância epidemiológica das infecções por SARS-CoV-2 (COVID-19) dentro dos serviços de saúde. (Complementar à nota técnica GVIMS/GGTES/ANVISA No. 04/2020) [Internet]. 2020 [cited 2020 Dec 5]. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
    https://www20.anvisa.gov.br/segurancadop...

  • Patients with positive PCR who remain asymptomatic and not severely immunosuppressed: exempt from the scheduled appointment and reschedule ten days after the first positive RT-PCR test for COVID-19.88 Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/Anvisa No. 07/2020. Orientações para prevenção e vigilância epidemiológica das infecções por SARS-CoV-2 (COVID-19) dentro dos serviços de saúde. (Complementar à nota técnica GVIMS/GGTES/ANVISA No. 04/2020) [Internet]. 2020 [cited 2020 Dec 5]. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
    https://www20.anvisa.gov.br/segurancadop...

  • Patients with positive PCR who remain asymptomatic and severely immunosuppressed: exempt from the scheduled appointment and reschedule 20 days after the first positive RT-PCR test for COVID-19.88 Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/Anvisa No. 07/2020. Orientações para prevenção e vigilância epidemiológica das infecções por SARS-CoV-2 (COVID-19) dentro dos serviços de saúde. (Complementar à nota técnica GVIMS/GGTES/ANVISA No. 04/2020) [Internet]. 2020 [cited 2020 Dec 5]. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
    https://www20.anvisa.gov.br/segurancadop...

In such cases, follow-up can be done by direct communication with the patient or preferably by remote technology means.

How to assess the priority of ultrasound exams in the context of the COVID-19 pandemic?

Exams must be analyzed using three types of priority:66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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  • Exams that must be done immediately without delay;

  • Exams that can be postponed without harm to the patient's care;

  • Exams that can be suspended during the pandemic period.

From this choice of priorities, the following points must also be considered:

  • The routine of ultrasound examinations covering specific periods of pregnancy in the course of the first or second semester;99 Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, et al. ISUOG practice guidelines: performance of firsttrimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102-13. doi: 10.1002/uog.12342
    https://doi.org/10.1002/uog.12342...
    1010 Salomon LJ, Alfirevic Z, da Silva Costa F, Deter RL, Figueras F, Ghi T, et al. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol. 2019;53(6):715-23. doi: 10.1002/uog.20272
    https://doi.org/10.1002/uog.20272...

  • Any history of genetic or structural abnormalities,99 Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, et al. ISUOG practice guidelines: performance of firsttrimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102-13. doi: 10.1002/uog.12342
    https://doi.org/10.1002/uog.12342...
    placental insufficiency (preeclampsia, fetal growth restriction),1111 Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol. 2019;53(1):7-22. doi: 10.1002/uog.20105
    https://doi.org/10.1002/uog.20105...
    1212 Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol. 2013;41(2):233-9. doi: 10.1002/uog.12371
    https://doi.org/10.1002/uog.12371...
    previous preterm birth, twin pregnancy,1313 Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247-63. doi: 10.1002/uog.15821
    https://doi.org/10.1002/uog.15821...
    as well as any previous maternal diseases harmful to pregnancy;1414 Organização Pan-Americana da Saúde, Ministério da Saúde, Federação Brasileira das Associações de Ginecologia e Obstetrícia, Sociedade Brasileira de Diabetes. Tratamento do diabetes mellitus gestacional no Brasil. Brasília (DF): OPAS; 2019.

  • If there are any risk factors that arose during the pregnancy period.

In these cases, the recommendations for performing obstetric and gynecological ultrasounds are as follows:

  • Select an experienced ultrasonographer to perform these exams, thereby minimizing the need for a second opinion;

  • Follow Febrasgo protocols to determine the time of exams in the first and second trimester of pregnancy and for the performance of gynecological exams;

  • If possible, for reduced time of direct contact with the patient, make videos of anatomical regions or capture specific screenshots and take biometric measurements offline.

What is the routine of obstetric exams for patients without preexisting maternal or fetal comorbidities?

  • In the first trimester (preferably between 11 and 14 weeks), the following should be evaluated: location of pregnancy, viability, number of fetuses and chorionicity, date of pregnancy, fetal anatomy and screening for aneuploidy and preeclampsia.66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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  • Perform morphological ultrasound at week 20-22 for the assessment of fetal static, cardiac activity, biometrics, basic fetal anatomy, fetal wellbeing and placental location.66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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  • Perform fetal growth screening exams during the third trimester.66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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Patients with comorbidities should use the guidelines provided in the previous item. However, the monitoring must be more rigorous and follow the specific protocols for each condition.66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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1515 Royal College of Obstetricians and Gynaecologists. Guidance for antenatal screening and ultrasound in pregnancy in the evolving coronavirus (COVID-19) pandemic: information for healthcare professionals: Version 1.1 [Internet]. 2020 [cited 2020 Nov 22]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf
https://www.rcog.org.uk/globalassets/doc...

How to proceed with ultrasound exams in hospitalized patients with suspected or confirmed cases of COVID-19 infection?

The ultrasound examination must be done by an experienced doctor, preferably at the bedside. The following must be evaluated: fetal statics, cardiac activity, biometrics, amniotic fluid volume, placenta and umbilical artery doppler velocimetry. Another important point is the assessment of fetal growth within four weeks after recovery.

How should the waiting environment for exams be organized in patients with and without suspected/confirmed COVID-19?

Ultrasound sector waiting room

In the waiting room environment, the distance of two meters between seats must be preserved with a maximum of one person in the examination room. Children or other relatives should not be allowed in this area. Patients should be advised to go unaccompanied to the examination site. To reduce the risk of transmission among health professionals, it is recommended that people who fit into a risk group do not stay in the waiting room, which is for exclusive use of scheduled patients.

Creation of an isolation room

The isolation room is recommended for patients with suspected COVID-19 or confirmed cases who need to perform a gynecological or obstetric examination in the ultrasound sector. These patients should be examined in an exclusive room with a bathroom.33 International Federation of Gynecology and Obstetrics (FIGO). Safe motherhood and COVID-19 [Internet]. 2020 [cited 2020 Nov 12]. Available from: https://www.figo.org/safemotherhood- and-covid-19
https://www.figo.org/safemotherhood- and...
It is important to ensure thorough cleaning of the equipment used.

Cleaning of the ultrasound room and its devices66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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Cleaning with appropriate disinfectant should be performed every morning in the morning, including the ultrasound monitor, computer keyboard and mouse, stretcher rails, transducer support, gel container, door handles, buttons, light switches, chairs and countertops.

Reduce the number of accessories on site that are not being used. These surplus accessories must be removed and kept in a clean, closed place. As for transducers connected to the ultrasound, only one trans-abdominal and one transvaginal are sufficient, used as required.

In the case of patients with suspected/probable/confirmed infection, the equipment should preferably be separated and used exclusively. It should always be sanitized, preferably with single-use gel packets, avoiding the usual containers. Prefer the use of disposable gloves and equipment.

What are the precautions with equipment and how should PPE be used in the ultrasound sector?

Some care is essential for professionals who have direct contact with patients or even with potentially infectious materials. This directly involves the use and access to PPE:55 Poon LC, Abramowicz JS, Dall’Asta A, Sande R, Ter Haar G, Maršal K, et al. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol. 2020;55(5):709-72. doi: 10.1002/uog.22027
https://doi.org/10.1002/uog.22027...

  • Pay attention to the time of use and removal of PPE; with gloves, for example, in order to avoid self-contamination and that of third parties, as the chance of contamination is greater if removal of this equipment is inappropriate;

  • Discard and perform the proper maintenance of non-disposable PPE.

Likewise, information on specific training on hygiene and instrument handling for health professionals should be provided, including doctors, nurses, technicians, cleaning, maintenance and administrative staff, among others.

Some important guidelines:1515 Royal College of Obstetricians and Gynaecologists. Guidance for antenatal screening and ultrasound in pregnancy in the evolving coronavirus (COVID-19) pandemic: information for healthcare professionals: Version 1.1 [Internet]. 2020 [cited 2020 Nov 22]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf
https://www.rcog.org.uk/globalassets/doc...

  • Make sure the ultrasound professional is experienced and has undergone infection control training;

  • Pay strict attention to hand hygiene, before and after contact with the patient. If you cannot wash your hands, use a disinfectant or an appropriate sanitizing product;

  • Give preference to single-use gel packets instead of using the gel directly from containers;

  • Use the transducer cover for non-endoluminal probes;

  • Always aim at reducing the exam duration.

Use of more specific equipment to treat patients with COVID-19 -confirmed or suspected/symptomatic/asymptomatic:55 Poon LC, Abramowicz JS, Dall’Asta A, Sande R, Ter Haar G, Maršal K, et al. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol. 2020;55(5):709-72. doi: 10.1002/uog.22027
https://doi.org/10.1002/uog.22027...
66 Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
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1515 Royal College of Obstetricians and Gynaecologists. Guidance for antenatal screening and ultrasound in pregnancy in the evolving coronavirus (COVID-19) pandemic: information for healthcare professionals: Version 1.1 [Internet]. 2020 [cited 2020 Nov 22]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf
https://www.rcog.org.uk/globalassets/doc...

  • Mask:

    1. - The patient must wear a face mask to avoid and/or reduce transmission by droplets;

    2. - The professional must follow the same hygiene rules and mandatorily use the facial mask;

    3. - Remove the mask carefully and always proceed with hand hygiene.

      1. Wash your hands with water and soap/ detergent for at least 20 seconds;

      2. Use specific products with alcohol in the concentration of 60%-95%;

      3. The ultrasound operator should preferably use a three-layer surgical mask.

  • Eye protection

    For eye protection, the use of a disposable facial protector that can protect the front and sides of the face is recommended. It should always be used when professionals are in the patient's room and in the service area.

    Two important aspects to be highlighted:

    1. - Glasses and contact lenses for personal use are not considered an appropriate eye protection;

    2. - Eye protection must always be removed when leaving the service area.

  • Gloves

    Appropriate care with gloves must include the following:

    1. - Always be clean when entering the service room;

    2. - Be removed and discarded when leaving the service area;

    3. - Hands should be cleaned after removing the gloves;

    4. - During the ultrasound examination, disposable gloves, preferably latex-free, should be used, which will be changed after the care of each patient.1515 Royal College of Obstetricians and Gynaecologists. Guidance for antenatal screening and ultrasound in pregnancy in the evolving coronavirus (COVID-19) pandemic: information for healthcare professionals: Version 1.1 [Internet]. 2020 [cited 2020 Nov 22]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf
      https://www.rcog.org.uk/globalassets/doc...

  • Aprons

    Disposable and non-disposable gowns can be used in patient care areas. Disposable gowns that can be placed in an appropriate disposal container before leaving the service area should be preferred.

Environmental infection control

It is mandatory to follow procedures for cleaning and disinfecting the ultrasound environment consistently and correctly. The control of environmental infection must aim at reusable materials that will be disinfected according to instructions provided by the manufacturer and supported by its installation and use policies. This also includes the care and management of objects and clothing of the team of professionals. Unusable material must be discarded according to health surveillance rules.

How to deal with employees and collaborators of the health team with COVID-19?

In case of confirmed cases of COVID-19 infection in the hospital service unit, recommendations are the following:

  • Put part of the health team to work remotely in order to avoid the simultaneous contamination of a relevant part of professionals and thereby, not impact the maintenance of services;

  • For professionals who already show symptoms of COVID-19 infection, flexible medical leave policies consistent with public health guidelines should be implemented.

Final considerations

This regulation covers different procedures that must be followed in the pandemic period of COVID-19 for the performance of obstetric and gynecological ultra-sounds in order to monitor and preserve the health of pregnant women and their fetuses, and of all professionals involved.

National Specialty Commission for Ultrasonography in GO of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO)

President:

Fabricio da Silva Costa

Vice-President:

Eduardo Becker Júnior

Secretary:

Heron Werner Júnior

Members:

Adriana Gualda Garrido

Anselmo Verlangieri Carmo

Fernando Maia Peixoto Filho

Guilherme de Castro Rezende

Joffre Amim Junior

Jorge Roberto Di Tommaso Leão

Luciano Marcondes Machado Nardozza

Luiz Eduardo Machado

Manoel Alfredo Curvelo Sarno

Patricia El Beitune

Pedro Pires Ferreira Neto

Sergio Kobayashi

References

  • 1
    Wataganara T, Ruangvutilert P, Sunsaneevithayakul P, Sutantawibul A, Chuchotirot M, Phattanachindakun B, et al. Minimizing cross transmission of SARS-CoV-2 in obstetric ultrasound during COVID-19 pandemic. J Perinat Med. 2020;48(9):931-42. doi: 10.1515/jpm-2020-0228
    » https://doi.org/10.1515/jpm-2020-0228
  • 2
    American College of Obstetricians and Gynecologists (ACOG). Novel Coronavirus 2019 (COVID-19): Practice Advisory [Internet]. 2020 [cited 2020 Nov 12]. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
    » https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019
  • 3
    International Federation of Gynecology and Obstetrics (FIGO). Safe motherhood and COVID-19 [Internet]. 2020 [cited 2020 Nov 12]. Available from: https://www.figo.org/safemotherhood- and-covid-19
    » https://www.figo.org/safemotherhood- and-covid-19
  • 4
    Colégio Brasileiro de Radiologia e Diagnóstico por Imagem. Recomendações gerais de prevenção de infecção pelo COVID-19 para clínicas e serviços hospitalares de diagnóstico por imagem [Internet]. 2020 [cited 2020 Jul 25]. Available from: https://cbr.org.br/recomendacoes-gerais-de-prevencao-deinfeccao- pelo-covid-19-para-clinicas-e-servicos-hospitalaresde- diagnostico-por-imagem/
    » https://cbr.org.br/recomendacoes-gerais-de-prevencao-deinfeccao- pelo-covid-19-para-clinicas-e-servicos-hospitalaresde- diagnostico-por-imagem
  • 5
    Poon LC, Abramowicz JS, Dall’Asta A, Sande R, Ter Haar G, Maršal K, et al. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol. 2020;55(5):709-72. doi: 10.1002/uog.22027
    » https://doi.org/10.1002/uog.22027
  • 6
    Declaração do Consenso ISUOG sobre a organização de serviços de ultrassonografia obstétrica de rotina e especializados no contexto da COVID-19 [Internet]. 2020 [cited 2020 Nov 25]. Available from: https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
    » https://www.isuog.org/uploads/assets/ab697155-d3fa-4818-abad79c3fecd8291/ISUOG-Consensus- StatementCOVID19Portuguese.pdf
  • 7
    Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas e Estratégicas. Manual de recomendações para a assistência à gestante e puérpera frente à pandemia de Covid-19 [Internet]. Brasília (DF): Ministério da Saúde; 2020 [cited 2020 Nov 25]. Available from:http://189.28.128.100/dab/docs/portaldab/documentos/corona/manual_recomendacoes_gestantes_covid19.pdf
    » http://189.28.128.100/dab/docs/portaldab/documentos/corona/manual_recomendacoes_gestantes_covid19.pdf
  • 8
    Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/Anvisa No. 07/2020. Orientações para prevenção e vigilância epidemiológica das infecções por SARS-CoV-2 (COVID-19) dentro dos serviços de saúde. (Complementar à nota técnica GVIMS/GGTES/ANVISA No. 04/2020) [Internet]. 2020 [cited 2020 Dec 5]. Available from: https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
    » https://www20.anvisa.gov.br/segurancadopaciente/index. php/alertas/item/nota-tecnica-gvims-ggtes-anvisa-n-07- 2020-atualizada-em-17-09-2020?category_id=244
  • 9
    Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, et al. ISUOG practice guidelines: performance of firsttrimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102-13. doi: 10.1002/uog.12342
    » https://doi.org/10.1002/uog.12342
  • 10
    Salomon LJ, Alfirevic Z, da Silva Costa F, Deter RL, Figueras F, Ghi T, et al. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol. 2019;53(6):715-23. doi: 10.1002/uog.20272
    » https://doi.org/10.1002/uog.20272
  • 11
    Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol. 2019;53(1):7-22. doi: 10.1002/uog.20105
    » https://doi.org/10.1002/uog.20105
  • 12
    Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol. 2013;41(2):233-9. doi: 10.1002/uog.12371
    » https://doi.org/10.1002/uog.12371
  • 13
    Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47(2):247-63. doi: 10.1002/uog.15821
    » https://doi.org/10.1002/uog.15821
  • 14
    Organização Pan-Americana da Saúde, Ministério da Saúde, Federação Brasileira das Associações de Ginecologia e Obstetrícia, Sociedade Brasileira de Diabetes. Tratamento do diabetes mellitus gestacional no Brasil. Brasília (DF): OPAS; 2019.
  • 15
    Royal College of Obstetricians and Gynaecologists. Guidance for antenatal screening and ultrasound in pregnancy in the evolving coronavirus (COVID-19) pandemic: information for healthcare professionals: Version 1.1 [Internet]. 2020 [cited 2020 Nov 22]. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf
    » https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidancefor- antenatal-screening.pdf

  • 1
    The National Specialty Commission for Ultrasonography in GO of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) endorses to this document. The content production is based on scientific studies on a thematic proposal and the findings presented contribute to clinical practice.

Publication Dates

  • Publication in this collection
    08 Mar 2021
  • Date of issue
    Jan 2021
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