Quyết định 775/QD-BYT

DECISION

GUIDELINES ON CARE AND MANAGEMENT FOR PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH COVID-19 AT HOME

MINISTER OF HEALTH

Pursuant to Law on Prevention and Control of Infectious Diseases in 2007;

Pursuant to the Law on Medical Examination and Treatment in 2009;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;

At request of Director of Department of Maternal Health and Children, Ministry of Health,

HEREBY DECIDES:

Article 1. The “Guidelines on care and management for pregnant women, lactating women, and infants infected with COVID-19 at home” are attached hereto.

Article 2. This Decision comes into effect from the day of signing.

Article 3. Department of Maternal Health and Children; Chief Ministry Office; Chief Ministry Inspectorates; directors and general directors of departments, general departments affiliated to Ministry of Health; directors of Health Departments of provinces and central-affiliated cities; heads of medical entities and heads of relevant entities are responsible for implementation of this Decree./.

GUIDELINES

CARE AND MANAGEMENT FOR PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH COVID-19 AT HOME
Attached to Decision No. 775/QD-BYT, dated March 28, 2022 of Minister of Health

I. OBJECTIVES AND REGULATED ENTITIES

1. Objectives

The “Guidelines on care and management for pregnant women, lactating women, and infants infected with COVID-19 at home” (hereinafter referred to as “Guidelines”) are developed in order to provide pregnant women, lactating women, and infants with mild SARS-CoV-2 infection with guidelines on specific management and care at home.

Care and management of pregnant women, lactating women, and infants infected with COVID-19 at home shall comply with “Guidelines on management of COVID-19 patients at home” (attached to Decision No. 604/QD-BYT dated March 14, 2022 of Minister of Health), amended documents (if any), and these Guidelines.

2. Regulated entities

a) Medical stations of communes, wards, town-level wards; mobile medical stations; medical centers of districts and clinics; emergency transport centers and facilities assigned to manage pregnant women, lactating women, and infants infected with COVID-19 at home;

b) Health workers and individuals managing pregnant women, lactating women, and infants infected with COVID-19 at home.

c) Pregnant women, lactating women, and infants infected with COVID-19 and their caregivers at home.

II. ELIGIBILITY OF PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH COVID-19 FOR RECEIVING CARE AT HOME

Adopt criteria under Section 2 of the “Guidelines on management of COVID-19 patients at home”, and:

1. For pregnant women

- Have no indications of pregnancy termination and no signs of labour;

- Do not have any of the following signs:

+ Constant and/or growing stomachache;

+ Vaginal bleeding;

+ Watery discharge;

+ Loss of consciousness or convulsion;

+ Swelling of face and limbs;

+ Headache, blurred vision;

+ No fetal movement (for pregnancy older than 20 weeks) or weak fetal movement;

+ Any other irregularity.

2. For infants

- Have no or mild clinical symptoms;

- Do not have any of the following signs:

+ Reduced nursing or breast refusal;

+ Hypersomnia;

+ Respiratory failure: respiration rate > 60 times/minute at 2 separate counts, agonal breathing, wheezing, flaring nostrils, chest retraction, episodes of stopped breathing longer than 20 seconds, SpO₂ < 96%;

+ Convulsion or loss of mobility; irregular movement;

+ Body temperature: Fever exceeds 38 ^oC and does not reduce after taking antipyretic or after 48 hours; body temperature drops below 36 ^oC after warming up;

+ Redness, swelling or discharge of the eyes; redness, swelling or discharge of belly buttons;

+ Dehydration: sunken eyes, chapped lips, wrinkling skin, decreased urine output;

+ Jaundice before 3 days old, especially during the first 24 hours after birth; jaundice that lasts longer than 14 days; jaundice that spreads to the abdomen, thighs, legs in the first few days after birth; jaundice of the palms or feet; growing jaundice; jaundice accompanied by discolored stool;

+ Digestion: Constant vomiting, abdominal bloating, blood in stool;

+ Other irregularity.

III. GUIDELINES ON MONITORING AND PROVIDING CARE FOR HEALTH OF PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH COVID-19 AT HOME

Prepare medicine and other supplies in accordance with Section 4 of the “Guidelines on management for COVID-19 patients at home”.

Implement routine care for pregnant women, postnatal women, lactating women, and infants in accordance with “National guidelines on Reproductive Health care services” (attached to Decision No. 4128/QD-BYT dated July 29, 2016 of Minister of Health) and take into account the following:

1. For pregnant women

1.1. Health monitor:

- Take body temperature reading at least twice a day in the morning, in the evening and when experiencing any irregularity. Count breathing rate, pulse, measure SpO₂ and blood pressure (if possible) on a daily basis.

- Check for pregnancy-related signs: fetal movement; any obstetric irregularity.

- Immediately inform health workers or have a checkup at medical facilities upon experiencing any irregularity under Section 5.1.3 of the “Guidelines on management of COVID-19 patients at home” or any emergency or obstetric irregularity under Section 1, Part II hereof.

1.2. Management and care during pregnancy

- Attend periodic antenatal care in accordance with the National guidelines on Reproductive Health care services. In addition, attend antenatal care whenever experiencing an irregularity or when indicated by health workers;

- If a pregnant woman does not experience any obstetric irregularity on the date of antenatal care, provide remote antenatal care or advise waiting until expiration of isolation period;

- Have a healthy diet, do healthy exercises, supplement micronutrients, refrain from smoking or come into contact with secondhand smoking, refrain from using alcoholic beverages and other stimulants, addictive substances;

- Maintain supplement of iron/folic acid or multi-micronutrient tablets as instructed by health workers (stop immediately after experiencing vomiting and/or diarrhea).

2. For women during postnatal periods and lactating women

- Take body temperature reading at least twice a day in the morning, in the evening and when experiencing any irregularity. Count breathing rate, pulse, measure SpO₂ and blood pressure (if possible) on a daily basis.

- Monitor lochia, uterine contractions, and detect any obstetric irregularity.

- Immediately inform health workers or receive a checkup at medical facilities upon experiencing any irregularity under Section 5.1.3 of the “Guidelines on management of COVID-19 patients at home” or upon experiencing any of the followings:

+ Growing hemorrhaging or blood blots;

+ Odor of lochia;

+ Violent abdominal pain or persistent and growing abdominal pain;

+ Irregular lumps, increase in size, or abscess in the perineum stitches (in case of vaginal delivery) or C-section scar;

+ Fever that exceeds 38 ^oC and does not reduce after taking antipyretic or after 48 hours;

+ Swelling of face, limbs, or blurred vision, or severe headache;

+ Convulsion;

+ Breasts: swelling, redness, tenderness, or nipple discharge;

+ Any other irregularity.

3. For infants

3.1. Daily health monitor

- Monitor general conditions of the infants: nursing, skin tone, stool, and urine;

- Take body temperature reading at least twice a day (regular body temperature of an infant ranges from 36,5 ^oC to 37,5 ^oC);

- Count breathing rate and measure SpO2 (if equipped with pulse oximeter) twice a day;

Note: Pulse oximeter for use in adults will not be accurate when used for infants, therefore, combine with monitoring infants’ wellbeing signs.

- Immediately inform health workers or bring infants to medical facilities as soon as the infants experience any dangerous sign under Section 2, Part II hereof.

3.2. Basic care for infants

Frequent rapid antigen test or RT-PCR test is not necessary for infants even when their caregivers are infected with COVID-19.

3.2.1. If a mother and her infant are infected with COVID-19:

+ Maintain breastfeeding. If the infant experiences stuffed nose and thus unable to sustain the breastfeeding, clean their nostrils prior to breastfeeding.

+ If the infant is unable to sustain the nursing, express breast milk and nurse manually with cup and spoon.

3.2.2. If only the mother is infected with COVID-19: Advise the mother and her family to consider the benefits of breastfeeding and risk of COVID-19 infection of the infants.

- In case the mother decides to breastfeed:

+ Wash hands regularly with soap and clean water or hand washing liquid prior to feeding the infant and wear face masks whenever staying close to the infant;

+ Wash breasts once per day during regular body wash; if droplets land on breasts because the mother coughs or sneezes, wash breasts with clean water and soap and immediately wipe dry;

+ If the infant is unable to sustain the feed, instruct the mother to express breast milk manually (or with the use of an equipment) and feed the infant using spoon and cup; wash hands regularly with clean water and soap or hand washing liquid prior to expressing breast milk; wear face masks while expressing milk and feeding the infant; cleaning expressing equipment, extractor, and feeding equipment such as spoon and cup (it is best to sterilize by steaming or soaking in boiling water);

- If the mother’s health deteriorates and she is unable to continue breastfeeding: Utilize sterilized milk from mother's milk bank (if any) or nurture the infant in accordance with guidance of health workers. Assist the mother in nursing the infant as soon as her health stabilizes.

IV. MEDICINE INSTRUCTIONS

1. For pregnant women and lactating women

- Antipyretic: use when body temperature exceeds 38,5 ^oC or severe headache, only use antipyretic which contains simply Paracetamol (with dose intended for adults under Section 5.2 of the “Guidelines on management of COVID-19 patients at home”).

- Medicine for other symptoms:

+ Cough: Use traditional methods such as lime, honey, sodium chloride 0,9% mouthwash. Medicine containing Dextromethorphan, Guaifenesin, etc. can be used as cough medicine or herbal cough medicine. Do not use medicine contraindicated for pregnant women and lactating women;

+ Stuffed nose, runny nose: spray or drop sodium chloride 0,9%;

+ Diarrhea: supplement with Oresol, zinc (10-20 mg/day).

- Continue using out-patient prescription drugs for any underlying medical condition or according to physician's indications.

Note: Do not use antiviral drugs, antibiotics, anti-inflammatory medicines for pregnant women, lactating women, etc. without indications and prescription.

2. For infants

- Antipyretic: use when body temperature exceeds 38,5 ^oC. Use Paracetamol at a dose of 10-15 mg/kg/instance (oral administration or rectal suppositories, and repeat after 4 - 6 hours if necessary; total dose must not exceed 60 mg/kg/day. If infants vomit within 15 minutes after taking medicine, give the infants another dose;

- Stuffed nose: Drop 2-3 drops of sodium chloride 0,9% in each nostril when the infants experience stuffed nose and have difficulty feeding. Warm the sodium chloride bottle in advance in this case.

Note:

- Do not subject the infants to steam inhalation therapy in any shape or form;

- Do not give infants antiviral drug, antibiotics, anti-inflammatory medicines, etc. without indications and prescription;

- Do not clear stuffed nose of infants using spray.

V. TASKS OF MEDICAL STATIONS AND FACILITIES THAT MANAGE TREATMENT AT HOME

1. Continue to manage pregnancy in accordance with the National guidelines on Reproductive Health care services; manage non-infectious diseases (gestational diabetes, hypertension, etc.) in pregnant women;

2. Manage COVID-19 patients at home in accordance with the “Guidelines on management of COVID-19 patients at home” attached to Decision No. 604/QD-BYT dated March 14, 2022 of Minister of Health and amending documents (if any);

3. Regularly maintain contact with pregnant women, lactating women, and family of infants infected with COVID-19 receiving treatment at home in order to give advice, mental support, and provide interventions if necessary.

4. Inform the mothers and families about hospital referral of pregnant women, postnatal women, and infants infected with COVID-19 in accordance with regulations of local governments.

5. Advise pregnant women, lactating women about COVID-19 vaccination in accordance with guidelines of Ministry of Health.