With the coronavirus in the news, there is concern about the health and safety of newborns.
Dr. Rakhi Dimino, Medical Director of Operations, discusses viral infections in Labor and Delivery.
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The Coronavirus in Labor & Delivery
Featured Speaker:
She is committed to decreasing maternal mortality and improving public health even outside her role with Ob Hospitalist Group. Dr. Dimino is a member of the board of directors for the Society of OB/GYN Hospitalists where she is also an editor and collaborator for the upcoming core competencies for OB/GYN hospitalists. She serves as a faculty member of the Texas AIM Plus Obstetric Hemorrhage Learning Collaborative to assist Texas hospitals with implementing AIM bundles to improve and standardize patient care during obstetrical emergencies. Dr. Dimino has had an active role with the Texas Medical Association for more than a decade and currently serves on their Council of Science and Public Health. She has participated in the TMA Texas Maternal Health Congress and has been a leader in coalescing ideas from physicians across the state to elevate maternal health. She is the chair of the Quality Committee for the Harris County Medical Society in Houston. She is also a member of the board of directors for The Health Museum in Houston.
Rakhi Dimino, MD
Dr. Dimino is a certified physician executive and earned a Master of Medical Management degree from Carnegie Mellon University. She completed residency at Barnes-Jewish Hospital / Washington University in St. Louis after she graduated from medical school at The Ohio State University. Her undergraduate degree from Northwestern University is in journalism. Dr. Dimino joined Ob Hospitalist Group in January 2013 after 7 years of private practice in Houston, Texas. She continues to work clinically as a hospitalist at Houston Methodist Willowbrook Hospital while she serves as a Medical Director of Operations.She is committed to decreasing maternal mortality and improving public health even outside her role with Ob Hospitalist Group. Dr. Dimino is a member of the board of directors for the Society of OB/GYN Hospitalists where she is also an editor and collaborator for the upcoming core competencies for OB/GYN hospitalists. She serves as a faculty member of the Texas AIM Plus Obstetric Hemorrhage Learning Collaborative to assist Texas hospitals with implementing AIM bundles to improve and standardize patient care during obstetrical emergencies. Dr. Dimino has had an active role with the Texas Medical Association for more than a decade and currently serves on their Council of Science and Public Health. She has participated in the TMA Texas Maternal Health Congress and has been a leader in coalescing ideas from physicians across the state to elevate maternal health. She is the chair of the Quality Committee for the Harris County Medical Society in Houston. She is also a member of the board of directors for The Health Museum in Houston.
Transcription:
Bill Klaproth: With the joy of pregnancy comes many concerns and now the threat of the Corona virus is causing even more concern. However, regardless of the type of virus, OB Hospital is our key to screening for viral exposure and care for women, fetuses and newborns. So what do you need to know about the threat of viral infection, including the Coronavirus when it comes to pregnancy, labor and delivery? Well, let's find out what Dr. Rakhi Dimino, a Board Certified OB GYN and an OB Hospitalist with OB Hospitalist Group. This is The Obstetrics Podcast from OB Hospitalist Group. I'm Bill Klaproth. Dr. Dimino, thank you so much for your time. So viral infections are a two way street. Either you have it and are spreading it or you pick it up from someone else. So when it comes time for labor and delivery, should women be concerned about going to the emergency room? Is that an overlooked entry point for the spread of viral infection?
Dr. Dimino: Labor and delivery is a key overlooked point in hospitals for the spread of viral infections. In general, when patients have an infection, they go through the main emergency room and main emergency rooms tend to have very good triage processes to keep patients who are infected away from patients who might not be infected. Unfortunately, many of our pregnant patients never go through the main emergency room. They actually access the hospital through labor and delivery itself directly, either through OB triage or an OB emergency room or as an admission for their induction or their C-section that's already been scheduled because of their direct entry into the labor and delivery unit, they are not screened in the same way. They will often walk through the entire unit, have conversations with nursing staff and physicians before they're asked their triage questions and so they can expose many other people to an infection before we realize that they might be infected.
Host: So as an OB Hospitalist, you're often the first line of defense when it comes to screening for viral infection?
Dr. Dimino: Yes, we are one of the very first people who see the woman in the room and start asking her, why is she here? What's bringing her into the hospital? If she has a cough or cold, we might be asking the questions about travel history or other pertinent things that may point us towards an infection like the Coronavirus or even something like the flu or the common cold.
Host: Right. So you play an important role in identifying risk and treating viral infection including the coronavirus?
Dr. Dimino: We do and what we're trying to do with our hospitals is move our triage process out of labor and delivery before the woman gets in her room and has already seen perhaps a nurse and then exposed to other patients as she's walking through the unit. So we're working with our hospitals on making sure that their processes are better than they have traditionally been on labor and delivery for screening for diseases and infections like the Coronavirus. When she's back in a patient room, then we would help care for that woman who might've been exposed to a virus and decide what type of supportive care or therapy that she may need for both her and her unborn child.
Host: So with the Coronavirus being on the minds of many, what are the symptoms we should be looking out for when it comes to the Coronavirus?
Dr. Dimino: The symptoms of the Coronavirus include a fever, cough, wheezing, malaise, fatigue, essentially the same symptoms that you would see with a cold or an influenza infection.
Host: Right. So it does share these common symptoms. So then what are the protocols of a woman does present with these types of symptoms?
Dr. Dimino: When a woman comes into the hospital seeking care and she has the symptoms that may point toward Coronavirus or flu or the common cold, she should be then asked travel questions. Has she been to one of the areas where there are a number of Coronavirus at confirmed cases? Has she been around somebody who has traveled to those areas? If the answer's yes, then we should immediately put a mask on her and all of the healthcare workers. So these are very specific masks that help prevent the spread of viral infections. They are not the common surgical masks that you see at the entrances of hospitals, but very specific masks that prevent the spread of viruses.
Host: With the Corona virus basically occupying the top spot in the news every day. I know many people are very, very concerned with this, but looking at things such as the flu and a cold and the Coronavirus which share common symptoms, what is the biggest current threat right now? What should we be really more concerned with at this present moment?
Dr. Dimino: The biggest threat for pregnant women and anybody else in the United States right now is actually influenza. Influenza isn't something that many of us are scared about because we hear about it all the time. Whereas Coronavirus, it seems new. It seems novel. The other Coronaviruses that we've heard about has been fairly deadly, like SARS or MERS, but influenza actually has killed more people in the United States and many more people have been infected with influence in the United States than we have seen with this Coronavirus worldwide. So we should still be very concerned about influenza. The symptoms are the same and in pregnancy, influenza can be deadly. It can cause pneumonias. It can cause trouble breathing. Women die of influenza, they go into preterm labor because of influenza. It is not the same type of infection when you are a healthy adult who is not pregnant,
Host: So that's a good reminder about the flu. We should not forget about that, but since most of our attention is being drawn to the Coronavirus, from what we've heard, 80% of the people will have mild symptoms, not a problem. It's the people with compromised immune systems, the elderly and the very young. Do we know at this point where a pregnant woman would fall into this?
Dr. Dimino: I think that's the most worrisome part of the Coronavirus in pregnancy. We don't have enough information about how it will affect a pregnant woman. We don't know if the Coronavirus will be more mild in pregnant women because they tend to be young, healthy adults or whether in pregnant women it will be a more deadly illness. Pregnancy comes with a type of compromised immune system. Your immune system does not work as well in pregnancy. It's why pregnant women tend to become more ill with influenza than their non pregnant counterparts. We also don't know whether a woman who is infected with Coronavirus will actually pass on the virus to her unborn child in utero or whether it will pass through breast milk. What we do know is that there have been infants, you've been infected with Coronavirus. Newborns who've been infected, in that circumstance, we're not sure if it by in utero infection or if it's by respiratory droplets. In other words, the mom is coughing and sneezing and then infecting her child. So that's something for us to really pay attention to as we gain more knowledge on Coronavirus.
Host: Right. At this point there are many unknowns, but that's where I think preparedness is the key and I think it's important to reiterate that OB Hospitalist Group is prepared with protocols. Should women present with symptoms of the Coronavirus, if it does start to spread across the United States?
Dr. Dimino: Absolutely. So working with our labor and delivery units is crucial. So our OB Hospitalists are prepared to help them with the triage process. Making sure that we provide good supportive therapy, isolate these women on a droplet precautions so that we can actually provide her with appropriate therapy to support her and her baby and still keep her our other patients safe.
Host: Which is comforting to know. And as we wrap up, Dr. Dimino, thank you so much. You've been very generous with your time. What should a woman do to protect herself from the Coronavirus or the flu or other viral infections?
Dr. Dimino: So whether it's Coronavirus or the flu or other viral infections, your protective measures are going to be exactly the same. Wash your hands, wash your hands, wash your hands. You were in a wash your hands for at least 20 seconds with soap and water. You can use alcohol based hand sanitizer when you don't have access to soap and water, but soap and water's still going to be the best protection. The other things that you would want to do is avoid being around sick people when you can, cover your costs and sneezes, perhaps avoid things like handshakes and switched to bumping fists or bumping elbows instead. And because then you are not bringing the virus onto your hands and touching your face and mouth as most people will with their hands multiple times through the day.
Host: So those are all things we can start doing right now. As you said, wash your hands, wash your hands, wash your hands for at least 20 seconds. Avoid being around sick people. Cover your own coughs and sneezes and avoid handshakes. Move to the fist bump or the elbow bump. That works as well. Well, Dr. Dimino, thank you so much. This has really been informative. Thank you so much for your time.
Dr. Dimino: Thank you.
Host: That's Dr. Rakhi Dimino and OB Hospitalists with OB Hospitalist Group. And you can follow Dr. Dimino on Twitter at DRR Dimino. That's D I M I N O, so it's at DRR Dimino. For more expert insights on women's healthcare, you can also visit OBHG.com for more information. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is The Obstetrics Podcast from OB Hospitalist Group. Thanks for listening.
Bill Klaproth: With the joy of pregnancy comes many concerns and now the threat of the Corona virus is causing even more concern. However, regardless of the type of virus, OB Hospital is our key to screening for viral exposure and care for women, fetuses and newborns. So what do you need to know about the threat of viral infection, including the Coronavirus when it comes to pregnancy, labor and delivery? Well, let's find out what Dr. Rakhi Dimino, a Board Certified OB GYN and an OB Hospitalist with OB Hospitalist Group. This is The Obstetrics Podcast from OB Hospitalist Group. I'm Bill Klaproth. Dr. Dimino, thank you so much for your time. So viral infections are a two way street. Either you have it and are spreading it or you pick it up from someone else. So when it comes time for labor and delivery, should women be concerned about going to the emergency room? Is that an overlooked entry point for the spread of viral infection?
Dr. Dimino: Labor and delivery is a key overlooked point in hospitals for the spread of viral infections. In general, when patients have an infection, they go through the main emergency room and main emergency rooms tend to have very good triage processes to keep patients who are infected away from patients who might not be infected. Unfortunately, many of our pregnant patients never go through the main emergency room. They actually access the hospital through labor and delivery itself directly, either through OB triage or an OB emergency room or as an admission for their induction or their C-section that's already been scheduled because of their direct entry into the labor and delivery unit, they are not screened in the same way. They will often walk through the entire unit, have conversations with nursing staff and physicians before they're asked their triage questions and so they can expose many other people to an infection before we realize that they might be infected.
Host: So as an OB Hospitalist, you're often the first line of defense when it comes to screening for viral infection?
Dr. Dimino: Yes, we are one of the very first people who see the woman in the room and start asking her, why is she here? What's bringing her into the hospital? If she has a cough or cold, we might be asking the questions about travel history or other pertinent things that may point us towards an infection like the Coronavirus or even something like the flu or the common cold.
Host: Right. So you play an important role in identifying risk and treating viral infection including the coronavirus?
Dr. Dimino: We do and what we're trying to do with our hospitals is move our triage process out of labor and delivery before the woman gets in her room and has already seen perhaps a nurse and then exposed to other patients as she's walking through the unit. So we're working with our hospitals on making sure that their processes are better than they have traditionally been on labor and delivery for screening for diseases and infections like the Coronavirus. When she's back in a patient room, then we would help care for that woman who might've been exposed to a virus and decide what type of supportive care or therapy that she may need for both her and her unborn child.
Host: So with the Coronavirus being on the minds of many, what are the symptoms we should be looking out for when it comes to the Coronavirus?
Dr. Dimino: The symptoms of the Coronavirus include a fever, cough, wheezing, malaise, fatigue, essentially the same symptoms that you would see with a cold or an influenza infection.
Host: Right. So it does share these common symptoms. So then what are the protocols of a woman does present with these types of symptoms?
Dr. Dimino: When a woman comes into the hospital seeking care and she has the symptoms that may point toward Coronavirus or flu or the common cold, she should be then asked travel questions. Has she been to one of the areas where there are a number of Coronavirus at confirmed cases? Has she been around somebody who has traveled to those areas? If the answer's yes, then we should immediately put a mask on her and all of the healthcare workers. So these are very specific masks that help prevent the spread of viral infections. They are not the common surgical masks that you see at the entrances of hospitals, but very specific masks that prevent the spread of viruses.
Host: With the Corona virus basically occupying the top spot in the news every day. I know many people are very, very concerned with this, but looking at things such as the flu and a cold and the Coronavirus which share common symptoms, what is the biggest current threat right now? What should we be really more concerned with at this present moment?
Dr. Dimino: The biggest threat for pregnant women and anybody else in the United States right now is actually influenza. Influenza isn't something that many of us are scared about because we hear about it all the time. Whereas Coronavirus, it seems new. It seems novel. The other Coronaviruses that we've heard about has been fairly deadly, like SARS or MERS, but influenza actually has killed more people in the United States and many more people have been infected with influence in the United States than we have seen with this Coronavirus worldwide. So we should still be very concerned about influenza. The symptoms are the same and in pregnancy, influenza can be deadly. It can cause pneumonias. It can cause trouble breathing. Women die of influenza, they go into preterm labor because of influenza. It is not the same type of infection when you are a healthy adult who is not pregnant,
Host: So that's a good reminder about the flu. We should not forget about that, but since most of our attention is being drawn to the Coronavirus, from what we've heard, 80% of the people will have mild symptoms, not a problem. It's the people with compromised immune systems, the elderly and the very young. Do we know at this point where a pregnant woman would fall into this?
Dr. Dimino: I think that's the most worrisome part of the Coronavirus in pregnancy. We don't have enough information about how it will affect a pregnant woman. We don't know if the Coronavirus will be more mild in pregnant women because they tend to be young, healthy adults or whether in pregnant women it will be a more deadly illness. Pregnancy comes with a type of compromised immune system. Your immune system does not work as well in pregnancy. It's why pregnant women tend to become more ill with influenza than their non pregnant counterparts. We also don't know whether a woman who is infected with Coronavirus will actually pass on the virus to her unborn child in utero or whether it will pass through breast milk. What we do know is that there have been infants, you've been infected with Coronavirus. Newborns who've been infected, in that circumstance, we're not sure if it by in utero infection or if it's by respiratory droplets. In other words, the mom is coughing and sneezing and then infecting her child. So that's something for us to really pay attention to as we gain more knowledge on Coronavirus.
Host: Right. At this point there are many unknowns, but that's where I think preparedness is the key and I think it's important to reiterate that OB Hospitalist Group is prepared with protocols. Should women present with symptoms of the Coronavirus, if it does start to spread across the United States?
Dr. Dimino: Absolutely. So working with our labor and delivery units is crucial. So our OB Hospitalists are prepared to help them with the triage process. Making sure that we provide good supportive therapy, isolate these women on a droplet precautions so that we can actually provide her with appropriate therapy to support her and her baby and still keep her our other patients safe.
Host: Which is comforting to know. And as we wrap up, Dr. Dimino, thank you so much. You've been very generous with your time. What should a woman do to protect herself from the Coronavirus or the flu or other viral infections?
Dr. Dimino: So whether it's Coronavirus or the flu or other viral infections, your protective measures are going to be exactly the same. Wash your hands, wash your hands, wash your hands. You were in a wash your hands for at least 20 seconds with soap and water. You can use alcohol based hand sanitizer when you don't have access to soap and water, but soap and water's still going to be the best protection. The other things that you would want to do is avoid being around sick people when you can, cover your costs and sneezes, perhaps avoid things like handshakes and switched to bumping fists or bumping elbows instead. And because then you are not bringing the virus onto your hands and touching your face and mouth as most people will with their hands multiple times through the day.
Host: So those are all things we can start doing right now. As you said, wash your hands, wash your hands, wash your hands for at least 20 seconds. Avoid being around sick people. Cover your own coughs and sneezes and avoid handshakes. Move to the fist bump or the elbow bump. That works as well. Well, Dr. Dimino, thank you so much. This has really been informative. Thank you so much for your time.
Dr. Dimino: Thank you.
Host: That's Dr. Rakhi Dimino and OB Hospitalists with OB Hospitalist Group. And you can follow Dr. Dimino on Twitter at DRR Dimino. That's D I M I N O, so it's at DRR Dimino. For more expert insights on women's healthcare, you can also visit OBHG.com for more information. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is The Obstetrics Podcast from OB Hospitalist Group. Thanks for listening.