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Dr Rahul Sen | Specialist care for birth and beyond | Sydney, Australia

Clinic conveniently located in Edgecliff : Freecall 1800 890 964

Latest COVID-19 Updates

COVID-19 Information

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COVID-19 Useful WebsitesAdvice On COVID-19 During PregnancyCOVID-19 Infection In PregnancySchedule of Antenatal VisitsDiabetes Screening and the GTT in Pregnancy

Latest Updates

COVID-19 Update Friday 15th July 2022

Fridays:
I will recommence consulting in Edgecliff on Fridays starting on 4 November 2022

Vaccine Update

As you know ATAGI and the federal government has offered a fourth dose of COVID-19 vaccination to everyone aged 30 or over and recommended it to everyone aged 50 or over.
At this stage the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has not made a recommendation regarding a fourth dose for pregnant women.
It looks as if the fourth dose may confer a small benefit for you and baby, so probably worth doing if you are happy to.
The benefit remains unproven, so it is fine not to do it if you are reluctant or if you have had a bad reaction previously.
The new Moderna vaccine includes the recent omicron variants in the vaccine. There is also good evidence that mixing vaccines confers a stronger benefit. The only problem is that Pfizer is the vaccine that has been far more widely studies in pregnancy than the others.
We do not have any long-term evidence on risks of either vaccine or infection in pregnancy. Women are more at risk of “long COVID” and babies can acquire COVID infection, which usually requires hospital admission for rehydration and feeding.
So on balance:
I recommend getting the vaccine if you are happy to.
Don’t worry about getting it you don’t want to.
Wait for an official recommendation from RANZCOG or ATAGI if you are undecided.
If you do get another vaccine then mixing vaccines may give stronger protection against COVID but Pfizer has been the most studied – you decide what is more important to you.
It is recommended you wait three months following COVID-19 infection or six months following your last COVID-19 vaccination before having a booster.

Stay well and stay safe

Rahul Sen

COVID-19 Update Monday 4th July 2022

COVID Positive
After dodging COVID for two years I finally got it last week, possibly from a family member or a close friend.
I was completely well until Tuesday night then developed fevers and chills and tested positive. I was only unwell for 24-48 hours. Now I feel completely fine, but am in isolation, as I am doubtless still infectious.
I am itching to get back to work, but I know I cannot until I can be sure that I do not represent a risk to you, your baby or any co-workers. That means being RAT negative. Studies show that RAT can take 1-2 weeks to become negative.
I am hoping to be back on Friday for my caesarean list, but my RAT test was positive this morning, and I am hoping it will become negative by Friday.

Current Situation
Things in the hospital remain stable. There have been some staff shortages, but by and large things are running well.
Partners returning to work and children at school, pre-school and day care appear to be the most common source of infection, hence the ongoing precautions around allowing children to attend rooms and visit hospital.

What to do if you test positive to COVID:
If you are unwell (including persistent fever 38.5ºC and above) or have breathing difficulty call an ambulance
If you are well or have mild symptoms:
Isolate at home, rest, keep up your fluids. Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home). Notify your delivery suite, who will notify me
Call an ambulance if you are very unwell or having difficulty breathing. If you have a saturation monitor your saturations should be 95% or more, otherwise call an ambulance
You cannot attend for blood tests, scans or consultations with your GP or me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 7 days and have a negative RAT before ending isolation
You need to continue to do RAT testing as long as you have no symptoms
You are supposed to do a PCR test if you have symptoms, but a RAT test if positive is sufficient

Pre-operative assessment:
You need to continue to perform RAT prior to admission. On the day of admission the hospital will do a rapid test.

Appointments in Rooms:
Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting
To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed
If you are running late please ring my rooms – I may need to reschedule your appointment
I prefer you do not bring other children to appointments, but I also understand that logistically that can be difficult, so if you need to bring another child that is OK as long as they do not have fever, cough, cold or runny nose.
Please do not come in or bring in anyone to the rooms with fever, cough, cold or runny nose
Please remember that if I develop COVID or respiratory symptoms I cannot attend the hospital for 7-14 days.

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person

3D Scans:
Partners (if asymptomatic) are now allowed in again – no other children

Fridays:
I am not consulting on Fridays for the next six months to provide support to my wife.

Stay well and stay safe

Rahul Sen

COVID-19 Update Friday 13th May 2022

Flu Vaccine
The influenza season has started much earlier this year than usual, and is predicted to be a much bigger season, with more serious infections, due to lack of exposure over the last couple of years.
Most women who get the Flu in pregnancy feel terrible for a few days and then get better, just like everyone else, but a small proportion of pregnant women develop a very serious infection and end up in ICU. This is of particular concern in the second and early third trimesters.

Current Situation
Things in the hospital remain stable. There have been some staff shortages, but by and large things are running well.
Partners returning to work and children at school, pre-school and day care appear to be the most common source of infection, hence the ongoing precautions around allowing children to attend rooms and visit hospital.

The best way to protect yourself and your baby is to get vaccinated and have a booster at 4 months.
It is likely that a fourth dose of the COVID-19 vaccination will be recommended this year, but I don’t know when

If you get COVID please delay your next dose of COVID 19 vaccination until 3 months from infection
The latest advice from ATAGI is to wait for 3 months from infection before you have your next dose of vaccine.

No news yet on fourth dose:
I think it likely that a fourth vaccine dose will be recommended in pregnant this year, but at this stage it is just three doses in pregnancy, unless you have another reason for a fourth dose, such as immunosuppression

Other Important Measures:
I am no longer advising that women need to work from home in the third trimester
I do recommend that you isolate from 37-38 weeks (or 2 weeks prior to planned or likely birth)
Avoid indoor groups of people, including public transport and family gatherings, especially last month of pregnancy
Wear a surgical mask whenever you are in an enclosed space with other people
Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if you test positive to COVID:
If you are unwell (including presistent fever 38.5ºC and above) or have breathing difficulty call an ambulance

If you are well or have mild symptoms:
Isolate at home, rest, keep up your fluids. Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home). Notify your delivery suite, who will notify me
Call an ambulance if you are very unwell or having difficulty breathing. If you have a saturation monitor your saturations should be 95% or more, otherwise call an ambulance
You cannot attend for blood tests, scans or consultations with your GP or me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 7 days and have a negative RAT before ending isolation
You need to continue to do RAT testing as long as you have no symptoms
You need to do a PCR test if you have symptoms

Pre-operative assessment:
You need to continue to perform RAT prior to admission. On the day of admission the hospital will do a rapid test

Appointments in Rooms:
Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting
To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed
If you are running late please ring my rooms – I may need to reschedule your appointment
I prefer you do not bring other children to appointments, but I also understand that logistically that can be difficult, so if you need to bring another child that is Ok as long as they do not have fever, cough, cold or runny nose.
Please remember that if I develop COVID or respiratory symptoms I cannot attend the hospital for 7-14 days.

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person

3D Scans:
Partners are now allowed in again – no other children

Fridays:
I am not consulting on Fridays for the next six months to provide support to my wife.

Stay well and stay safe

Rahul Sen

COVID-19 Update Tuesday 29th March 2022

Current Situation

The new COVID-19 variant BA-2 is highly contagious, but so far does not appear to cause major clinical problems, just like the previous Omicron variant. Overseas there is a hybrid between the previous Delta and Omicron strains. It is too early to tell whether this will be a problem or not.

Things in the hospital remain very stable, however we have started to see an increase in staff sickness with the new variant, and it remains to be seen how much of an effect that will have on the functioning of the hospital. It may be that all non-urgent admissions are postponed.

With the increase in community infection the hospital will be very cautious with visitors and that may result in an increase in visitor restrictions. Children at school, pre-school and day care appear to be the most common source of infection, hence the ongoing precautions around allowing children to attend rooms and visit hospital.

The best way to protect yourself and your baby is to get vaccinated and have a booster at 4 months.

It is likely that a fourth dose of the COVID-19 vaccination will be recommended this year, but I don’t know when

Make sure you are not alone in the hospital when you give birth:
The one big issue remains that if you or your partner or child has COVID in the 1-2 weeks prior to birth you will not be allowed to bring any support person into the hospital with you
Take whatever steps you can take to make sure that you have a support person with you

Other Important Measures:
I am no longer advising that women need to work from home in the third trimester
I do recommend that you isolate from 37-38 weeks (or 2 weeks prior to planned or likely birth)
Avoid indoor groups of people, including public transport and family gatherings, especially last month of pregnancy
Wear a surgical mask whenever you are in an enclosed space with other people
Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if you test positive to COVID:
If you are unwell (including fever 38.5ºC and above) or have breathing difficulty call an ambulance

If you are well or have mild symptoms:
Isolate at home, rest, keep up your fluids. Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home). Notify your delivery suite, who will notify me
Call an ambulance if you are very unwell or having difficulty breathing. If you have a saturation monitor your saturations should be 95% or more, otherwise call an ambulance
You cannot attend for blood tests, scans or consultations with your GP or me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 7 days and have a negative RAT before ending isolation
You need to continue to do RAT testing as long as you have no symptoms
You need to do a PCR test if you have symptoms

Pre-operative assessment:
You need to continue to perform RAT prior to admission. On the day of admission the hospital will do a rapid test

Appointments in Rooms:
Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting
To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed
If you are running late please ring my rooms – I may need to reschedule your appointment

Flu Vaccine
The 2022 Influenza vaccine is available. I recommend having it either now or in May/June depending on due date

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person

3D Scans:
Partners are now allowed in again for 3D scans if vaccinated, as they are again at Ultrasound Care

Easter:
I will be going away for four days from the evening of Thursday 14th until the afternoon of Monday 18th April.

Stay well and stay safe

Rahul Sen

COVID-19 Update Monday 21 February 2022

Prince of Wales Private Hospital Update to Visitor Restrictions effective Monday 21 February 2022

COVID-19 Update Friday 18th February 2022

Current Situation

Things in the hospital are very stable and now returning to near normal. Our desperate shortage of staff from COVID leave has now become a minor but manageable staff shortage.

Most women who get the current Omicron variant of COVID get a mild flu-like illness and get better within a few days. There have been no reported adverse outcomes for babies and no increase in risk of pre-term birth, unlike the situation with the original strains and prior to vaccination.

I have had one woman admitted to intensive care with COVID this week. Fortunately she it stable.

Vaccination Protects You

The best way to protect yourself and your baby is to get vaccinated and have a booster at 4 months.

Virtually all (around 90%) of people admitted to hospital with severe COVID are unvaccinated.

Make sure you are not alone in the hospital when you give birth:

The one big issue remains that if you or your partner or child has COVID in the 1-2 weeks prior to birth you will not be allowed to bring any support person into the hospital with you.
Take whatever steps you can take to make sure that you have a support person with you.

Protect Yourself and Your Baby:
Other Important Measures:
Isolate from 37-38 weeks (or 2 weeks prior to planned or likely birth)
Avoid indoor groups of people, including public transport and family gatherings, especially last month of pregnancy
Wear a surgical mask whenever you are in an enclosed space with other people;
Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if you test positive to COVID:
If you are unwell (including fever 38.5ºC and above) or have breathing difficulty call an ambulance
If you are well or have mild symptoms:
Isolate at home, Rest, Keep up your fluids. Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home). Notify your delivery suite, who will notify me.
Call an ambulance if you are very unwell or having difficulty breathing. If you have a saturation monitor your saturations should be 95% or more, otherwise call an ambulance.
You cannot attend for blood tests, scans or consultations with your GP or with me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 7 days and have a negative RAT before ending isolation
You need to continue to do RAT testing as long as you have no symptoms
You need to do a PCR test if you have symptoms

Pre-operative assessment:
You need to continue to perform RAT prior to admission. On the day of admission the hospital will do RAT and a rapid PCR test.

Appointments in Rooms:
Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting
To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed
If you are running late please ring my rooms – I may need to reschedule your appointment

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person.

3D Scans:
Partners are now allowed in again for 3D scans if vaccinated, as they are again at Ultrasound Care

Stay well and stay safe.

Rahul Sen

COVID-19 Update Monday 24th January 2022

Just to clarify the situation regarding partners of COVID positive women.

This is the latest update from POWPH:

With increasing numbers of maternity patients testing positive to COVID and the requirement for support during birth, we have revised the visiting guideline for the birthing support person:

  • COVID positive mother – COVID negative support partner can attend to support the mother in the birthing suite and theatre for a LSCS
  • COVID negative support person must wear an N95 mask and eyewear protection at all times – this will be provided by the Hospital
  • COVID negative support person must leave the hospital after delivery, and cannot return to the Hospital once they leave i.e. the support person will not be able to stay for the post-natal part of the admission when the COVID positive patient will be nursed in the COVID pod.

Please Note-

  • Only one (1) support person will be allowed
  • If the mother is COVID negative and the partner is COVID positive, the partner will not be able to attend the Hospital. However another support person can be nominated providing they are COVID negative

Please be advised:

If a mother is COVID positive and the partner is COVID negative, the partner can attend for the birth but cannot stay the for the whole admission.

The partner must wear an N95 mask and eyewear protection for the duration of the visit (this will be provided).

If the mother is COVID negative and the partner is COVID positive, unfortunately the partner will not be able to attend the Hospital, however another support person (COVID negative) may be nominated, however only one support person will be allowed.

Best wishes and stay safe.

Rahul

COVID-19 Update Friday 21st January 2022

Current Situation

Around 20% of my patients are either currently positive or recently positive for COVID-19.

The good news is that unlike the first wave of COVID-19, which was associated with potentially serious pregnancy outcomes, the current wave does not appear to be associated with any known adverse pregnancy outcomes.

We have regular meetings to discuss medical complications in pregnancy and the consensus at the moment is that the current wave is not nearly as dangerous as previous waves.

There does not appear to be an increase in pre-term or early birth in women who develop COVID-19 in pregnancy with the omicron strain, especially if they have received two or preferably three vaccine doses.

One of the unknown issues remains growth restriction in the baby. I will continue to monitor all babies for growth, especially in the third trimester, as I did in any case even prior to COVID-19.

Most women have a flu-like illness that resolves within 3-4 days. This is often associated with low-grade fever, scratchy throat, runny or blocked nose, headache and joint ache.

Protect Yourself and Your Baby:

The ONLY women who have had severe illness or an adverse affect on pregnancy in my experience are women who have not been vaccinated.

The best way to protect yourself and your baby is to get vaccinated and have a booster at 4 months.

The vaccine will be offered at 3 months to some women.

Pfizer and Moderna appear to be equally effective, however Pfizer is the most studied in pregnancy.

Virtually all (around 90%) of people admitted to hospital with severe COVID-19 are unvaccinated.

The biggest problem in the current climate is partners not being allowed into hospitals

Latest news from POWPH – partners allowed if RAT negative and no symptoms

Partners are not allowed in for birth if they are symptomatic or rapid antigen test positive.

However for women who are positive their partners can now join them in hospital if the partner is RAT negative.

Other Important Measures:

Stay at home and you work from home in the third trimester – I can provide a certificate;

You and your partner self isolate from 37 weeks

Avoid indoor groups of people, including public transport and family gatherings, especially in the third trimester;

Wear a surgical mask whenever you are in an enclosed space with other people;

Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if your partner tests positive to COVID:

Partner needs to isolate for 10 days and have a negative RAT before ending isolation (these rules change often)

You need to continue to do RAT testing as long as you have no symptoms

You need to do a PCR or RAT test if you have symptoms and are not known to be COVID positive

Pre-operative assessment:

You need to continue to perform RAT prior to admission. On the day of admission the hospital will do RAT and a rapid PCR test.

Appointments in Rooms:

Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting

To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed

If you are running late please ring my rooms – I may need to reschedule your appointment

Zoom Appointments:

Zoom appointments will be available for women who are COVID positive and unable to attend in person.

This is an anxious time, but I will be around when you really need me.

In the meantime stay well, stay safe, and have a happy and healthy 2022

Rahul Sen

COVID-19 Update Tuesday 4 January 2022

Asymptomatic Screening
You no longer need to do PCR testing every 72 hours if you have no symptoms. The time spent waiting in queues and for results has made this a pointless exercise. Instead it is recommended you and your partner do rapid antigen testing (RAT) at home every 72 hours from 37 weeks or earlier if you are at risk of early birth.
I recommend the following brands of rapid antigen test (RAT) which have shown very high detection rates at testing (but you may have little or no choice): All test, Lyher, Onsite, Panbio and V-Chek.

Current Situation
There is massive and increasing community transmission and every day more patients and colleagues are testing positive. There is now a staffing shortage in all hospitals, made worse by the lack of overseas staff.
It may well be that we all end up getting COVID. It remains the case, however, that the serious outcomes have occurred almost exclusively in women who are not fully unvaccinated. I still recommend taking all precautions.

Protect Yourself and Your Baby:
The best way to protect yourself and your baby is to get vaccinated and have a booster every 5-6 months.
Virtually all (around 90%) of people admitted to hospital with severe COVID are unvaccinated.

Other Important Measures:
Stay at home and you and your partner work from home in the third trimester – I can provide a certificate;
Avoid indoor groups of people, including public transport and family gatherings, especially in the third trimester;
Wear a surgical mask whenever you are in an enclosed space with other people;
Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if you test positive to COVID:
If you are unwell (including fever 38.5ºC and above) or have breathing difficulty call an ambulance
If you are well or have mild symptoms:

  • Isolate at home
  • Rest
  • Keep up your fluids
  • Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home)
  • Notify your delivery suite, who will notify me. My staff will register you with CTAC. At some stage the NSW Health team should monitor you and provide you with an oxygen saturation monitor, however the service has been swamped with demand. Call an ambulance if you are very unwell or having difficulty breathing. If you have a saturation monitor your saturations should be 95% or more, otherwise call an ambulance
  • You cannot attend for blood tests, scans or consultations with your GP or with me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 7 days and have a negative RAT before ending isolation (these rules change often)
You need to continue to do RAT testing as long as you have no symptoms
You need to do a PCR test if you have symptoms

Pre-operative assessment:
You need to continue to perform RAT prior to admission. On the day of admission the hospital will do RAT and a rapid PCR test.

Appointments in Rooms:
Only one person or couple in the rooms at any one time – please wait outside if someone is already waiting
To ensure waiting times are kept to a minimum I may need to prioritise issues to be addressed
If you are running late please ring my rooms – I may need to reschedule your appointment

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person.

This is an anxious time, but I will be around when you really need me.

In the meantime stay well, stay safe , and have a happy and healthy 2022

Rahul Sen

COVID-19 Update Thursday 30th December, 2021

Breaking News
You no longer need to do PCR testing every 72 hours if you have no symptoms. The time spent waiting in queues and for results has made this a pointless exercise. Instead it is recommended you and your partner do rapid antigen testing (RAT) at home every 72 hours. Rapid antigen tests will doubtless be in short supply, but like toilet paper there will be availability again at some stage.
I recommend the following brands of rapid antigen test (RAT) which have shown very high detection rates at testing (but you may have little or no choice): All test, Lyher, Onsite, Panbio and V-Chek.

Current Situation
There is massive and increasing community transmission and every day more patients and colleagues are testing positive. There is now a staffing shortage in all hospitals, made worse by the lack of overseas staff.
It may well be that we all end up getting COVID. It remains the case, however, that the serious outcomes have occurred almost exclusively in women who are not fully unvaccinated. I still recommend taking all precautions.

Protect Yourself and Your Baby:
The best way to protect yourself and your baby is to get vaccinated and have a booster every 5-6 months.

Please read the following statement from Professor Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford and chief investigator of the UKOSS national study of pregnant women admitted to hospital with COVID-19:
“This new data clearly shows that outcomes of covid-19 for pregnant women and their babies are getting worse. However, it also shows the very strong protection that receiving a vaccination provides. With several hundred thousand pregnant women across the world having received a vaccine, it is clear that vaccination in pregnancy is safe. As infections increase, pregnant women can be reassured that getting a vaccine is the best way to protect them and their babies.”

Other Important Measures:
Stay at home and you and your partner work from home in the third trimester – I can provide a certificate;
Avoid indoor groups of people, including public transport and family gatherings, especially in the third trimester;
Wear a surgical mask whenever you are in an enclosed space with other people;
Exercise outdoors on a daily basis for physical and mental wellbeing

What to do if you test positive to COVID:
If you are unwell (including fever 38.5ºC and above) call an ambulance.
If you are well or have mild symptoms:

  • Isolate at home
  • Rest
  • Keep up your fluids
  • Take Panadol for headache, joint ache or fever up to 38.4ºC (have a thermometer at home)
  • Notify your delivery suite, who will notify me. I will register you with CTAC. At some stage the NSW Health team will monitor you and provide you with an oxygen saturation monitor. Your saturations should be 95% or more, otherwise call an ambulance
  • You cannot attend for blood tests, scans or consultations with your GP or with me, however I will do Zoom appointments

What to do if your partner tests positive to COVID:
Partner needs to isolate for 10 days and have a negative RAT before ending isolation (these rules change often)
You need to continue to do RAT testing as long as you have no symptoms

New Year Break:
The office will be closed on 31 December and open again from Tuesday 4 January.
I will be in the office on Tuesday 4 January and Thursday 6 January for critical and emergency appointments

Zoom Appointments:
Zoom appointments will be available for women who are COVID positive and unable to attend in person.

This is an anxious time, but I will be around when you really need me. In the meantime stay well, stay safe and have a happy, healthy (but very quiet) festive season.

Rahul Sen

COVID-19 Update Friday 10th September, 2021

Good News
The seriously unwell woman in ICU has now woken up and is out of ICU.

Current Situation
Today’s update will be brief.
Many of you were understandably concerned about the serious situation I described in my last update on 31st August.
I am happy to say that the critically ill women, including the woman who was ventilated, have all recovered and are now out of ICU. Many have gone home.
None of them has so far had to deliver their baby early.
We have now had one recent COVID caesarean section at RHW. There will be more to come.
Please remember the wave of infection is on now spreading back to this region.
When we had had 4 COVID maternity cases Westmead had had 300.
We can expect many more cases, especially at RHW but likely at POWPH as well.

Vaccination
I would say that around 90% of my patients have now decided to be vaccinated.
I can say that for a lot of women who were initially undecided and then decided to take the plunge and get the vaccine there has been almost a universal sense of relief that not only do they need to struggle with the decision any longer but that both they and their baby are now protected to the best of our ability.

Future
The further good news is that increasing volumes of vaccine are becoming available.
I expect that the current numbers will continue for another month and only then start to decline
I know that the end of lockdown has been promised for October, but I think the risk will not subside significantly until around December.
It is quite likely that we never go back to elimination, as we had six months ago, and instead learn to live with the virus
From next year we will probably rely on annual boosters and hope that a mutant strain does not develop that is resistant to the current vaccines
Follow up studies from overseas suggest that the Astra Zeneca vaccine may last longer than the Pfizer and Moderna vaccines.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Tuesday 31st August 2021

Current Situation
Last weekend I was the consultant on call for the public hospital, RHW.
I witnessed first-hand the potential seriousness of COVID-19 infection in pregnancy.
We had four pregnant women admitted to the campus, three of whom were in the intensive care unit.
Two were breathing for themselves, but feeling very breathless and needing oxygen via nasal prongs
One of the women deteriorated to the point where she needed to be intubated (induced coma). She is 26 weeks pregnant. As her life and that of her baby hang in the balance, we pray for their speedy and complete recovery.
Over the last few months my advice on immunization against COVID-19 has changed significantly.
Six months ago we had no cases of COVID infection and the known risks of immunization extremely low, and the unknown risks purely theoretical and likely to be minimal.
The risk-benefit analysis at that time justified a wait and see approach.
Now the situation has changed dramatically.
The risk profile of vaccination, has if anything reduced, because there is now an increasing body of published data about short term safety of vaccination, which is very reassuring.
On the other hand the number of COVID cases in the community is high and increasing. Of particular concern is the number of community cases not known to be linked to known cases
If we are to eliminate cases we will need prolonged, hard lockdown and good community compliance, neither if which has happened in any meaningful way to date.
It is quite possible that we will not eliminate this virus and will instead have to learn to live with it and rely on high rates of immunization and boosters in the community.
Serious infection only occurs in the unvaccinated.
The best way to protect yourself and your baby is to get vaccinated.
Vaccination early in pregnancy appears to offer better protection to the baby. I recommend from 12-14 weeks onwards, although RANZCOG and ATAGI recommend at any stage of pregnancy.
Pfizer is the recommended vaccine for pregnant and breast feeding women.
Two to three weeks ago there was a shortage of vaccine. Now there are increasing supplies, especially through local GPs.
For everyone wanting to have the vaccine but not during pregnancy please make sure you have the vaccine as soon as possible after the baby is born. Breastfeeding will still provide the baby with some immunity.
For everyone I am recommending self isolating at home from 37 weeks and also undergoing COVID-19 testing every three days from 37 weeks.

Getting the Vaccine
Pregnant women are eligible for the vaccine, and can use the Australian Government Eligibility Checker to arrange an appointment.
Please note: When using the eligibility checker, pregnant women should tick ‘no’ to AstraZeneca and keep going to the end.
Pregnant women should get vaccinated and continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. This includes hand hygiene, masks where social-distancing cannot be maintained, testing when symptoms are present and isolation, when appropriate.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Friday 20th August 2021


COVID Cases
681 in NSW yesterday
There are now COVID-19 cases in hospital, including pregnant women
We are getting daily bulletins and updates.

What is the latest on the Randwick campus:
We have COVID cases in hospital, including in our ICU – this is going to get worse
We have pregnant women with COVID on our campus, some of whom are very sick

This is the latest information and advice I have:
What should pregnant women do to avoid catching the virus:

  • Limit unnecessary interactions with persons who might have been exposed to or might be infected with COVID, including within their household;
  • When leaving the house or interacting with others wear a mask, social distance, avoid persons who are not wearing a mask, sanitize and wash hands frequently’
  • Take measures to promote general good health, including mental health, including rest, eating healthily, doing regular exercise, getting fresh air and attending regular visits;
  • Get vaccinated

Vaccine safety: Study of over 35,000 women in the USA who have had Pfizer – no evidence of adverse affects on the women or their babies (Shimabukuro T, NEJM, June 2021).
More than 100,000 women have now had COVID vaccination in pregnancy
There have been fears about COVID-19 vaccination affecting fertility – there is no evidence at all that this is the case
What are the risks of vaccination in general:
Astra Zeneca: 1 in 1 million risk of death from thrombosis
Pfizer: 1 in 1 million risk of death from myocarditis/pericarditis
Flu vaccine: 1 in 1 million risk of Guillain Barre syndrome
COVID infection in Sydney: nearly 30 deaths ie about 8 in 1 million – ONLY in those unvaccinated

Hospital Protocol
As you know everyone coming into hospital now needs to have had a negative COVID test within the last 72 days, that means all pregnant women and their partners
I recommend testing every 3 days from 37 weeks
Anecdotally the testing has been quicker with most result available within 8-12 hours, except for Laverty Pathology, which has been longer
The hospital has a limited supply of rapid tests, for those who have. We have already run out once, so please do not rely on this as an option. The consequence could be full PPE and delay in having a support person

Based on the current situation I strongly urge you to get the COVID vaccine, self isolate from 37 weeks and do regular testing. Vaccination is the best way to protect yourself and your baby at this time.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Friday 6th August 2021

COVID Cases
291 local cases of COVID-19 in the last 24 hours, of which 96 were infectious in the community.

Lockdown
I predict we will need three months of hard lockdown (ie until December) with good community compliance to get back to where we were three months ago. At the moment we have a semi-hard lockdown with good community compliance in some areas but poor community compliance in others.

COVID-19 Vaccination
I have no doubt that in the current environment it is safer for you and for your baby to be vaccinated with the Pfizer vaccine.
The latest app to assist with getting the vaccine is: https://covidqueue.com/
I am pleased to report that around 80% of my patients have advised that they are now vaccinated or booked for vaccination within the next two months.

When to get vaccinated
The RANZCOG and ATAGI guidelines advise that vaccination can be safely done at any stage of pregnancy.
Knowing that the risk of miscarriage is reduced after 8 weeks of pregnancy, and that is nothing to do with COVID-19, and further reduced at 14 weeks, by which time you have usually had the NIPT and early structural scan I feel that the best time to have the vaccine is between 14 and 36 weeks.

POWPH: Please see current guidelines about screening prior to admission:
The Hospital now requires patients residing in affected Local Government Areas (LGAs) to provide a negative COVID test prior to admission at the Hospital. Once you have had your test you should isolate as much as possible prior to your admission.
At this stage women and their partners are both allowed into the maternity ward. Partners at present are allowed to come and go but are encouraged not to. It is possible that partners will need to commit to staying the entire admission. It is unlikely, although possible, that partners will not be allowed in – this would only happen if local cases escalate dramatically.
The list of affected LGAs is on the NSW Government website: https://www.nsw.gov.au/covid-19/rules/greater-sydney#other-reasonable-excuses.

Consultations in Rooms
If you are coming from an affected area please have a COVID test before your face to face appointment in my rooms.  I have a form letter explaining that you are pregnant and need to attend for a medical appointment. Please ask my secretary to print a letter if you need one. It can be emailed to you.

Everyone who needs or wants a face to face visit in pregnancy for a scan will continue to have one.

I am trying to minimise any risk to everyone, by limiting your time in the consulting rooms. Please come alone, wear a mask, and reschedule your appointment if you have any respiratory symptoms.

Please make all appointments and do all payments by phone.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Friday 2 July 2021


Lockdown
The number of local cases continues to be very low – around 20 per day, which is encouraging.

I still believe the lockdown will last longer than two weeks.

Hospitals
I have so far had to do two caesarean sections for women without their partner being present, one last year and one this week.

In both cases the partner did not actually have COVID-19, but the woman or her partner had fever, respiratory symptoms or were required to quarantine because of exposure to COVID-19.

It is critically important, especially in the last weeks of your pregnancy to avoid or at least minimise any exposure that might lead to the need to quarantine.

Similarly if you have any symptoms please get your COVID-19 test as soon as possible, which increases the chance you will be allowed into hospital along with your partner.

COVID-19 Vaccine
At this stage no news on the availability of the Pfizer vaccine for pregnant women in NSW.

I will let you know as soon as pregnancy is added to the list of indications for the vaccine.

I have done a form letter, especially for women in the third trimester. You can take the letter to a vaccination hub or GP who administers the Pfizer vaccine.

There are several doses of the vaccine in each vial. It is usual and recommended practice to offer any “left over” doses to people who want them rather than waste the doses.

This approach does not have the same guarantee of getting the vaccine as a booked appointment at a hub, but it might work and is the best I can offer at this time.

There is a vaccination hub at Sydney Children’s Hospital, Randwick, but it is booked out until September.

COVID-19 Infection and Pregnancy
Pregnant women do not appear to be more likely to get COVID 19 than the general population, nor is the infection generally worse in pregnancy. Those things may change with the new delta variant.

At this stage the main risk of infection in pregnancy appears to be a risk of pre-term birth.

The long term implications of COVID-19 infection in pregnancy are unknown.

There is information on the RANZCOG website that is updated regularly: https://ranzcog.edu.au/statements-guidelines/covid-19-statement

Consultations in Rooms
Everyone who needs or wants a face to face visit in pregnancy will continue to have one.

I am trying to minimise any risk to everyone, by limiting your time in the consulting rooms. Please come alone, wear a mask, and defer your appointment if you have any respiratory symptoms.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Monday 28 June 2021

Lockdown
We are now back in lockdown.

This is a slightly scary time, but we have been here before and we got through it. We will get through it again.

The new (Delta) variant of the virus appears to be far more contagious and to affect younger people.

The lockdown may well last more than the two weeks. During that time I will ensure that everyone who needs to be seen will be seen, but that all face to face contact is kept to a minimum.

All current appointments will be replaced with a Zoom appointment first then a face to face appointment to check your blood pressure, examine your abdomen and scan your baby.

If a BP check and scan are not necessary then we can do Zoom only – eg 24 week visit, if you are happy.

Please do not bring partners, family or friends to your face to face appointment. My secretaries are trying to ensure that everyone is booked for their correct appointments. One of my secretaries is isolating at home. I am trying to ensure that I avoid having to isolate or quarantine, so that I can continue to see you for scans and be there when you have your baby.

COVID-19 Vaccine
At this stage no news on the Pfizer vaccine

I will let you know as soon as pregnancy is added to the list of indications for the vaccine.

Hospitals
At this stage women and their partners are both allowed into the hospitals.

No other visitors are allowed.

It is important that women approaching their due date, ie from 37 weeks onwards, self isolate, along with their entire household.

The reason for self isolating is to prevent not only COVID-19 infection, which is now widespread in this part of Sydney, but also to reduce any respiratory symptoms, bearing in mind this is winter.
It is important to understand that if you come into hospital with a fever or flu-like symptoms then until you are cleared for COVID-19 you will have to wear full PPE and so will everyone looking after you.

If you are suspected to have COVID-19 then until you are cleared you will not be allowed even your partner and there will be early recourse to epidural and caesarean, because the emergency caesarean section in the COVID-19 setting takes over an hour to set up.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Friday 25 June 2021

COVID-19 Vaccine
As you know the peak bodies last week recommended vaccination against COVID-19 for all pregnant women, regardless of stage of pregnancy.

The Pfizer vaccine is the one recommended.

At this stage pregnancy has not been added to the list of indications for vaccination in NSW. Please be patient, it will happen.

If you have had one dose of Astra Zeneca the recommendation is to complete the course with the second dose of Astra Zeneca.

Where possible you should avoid having any other vaccine within one week of either Flu or Pertussis (whooping cough) vaccine.

Nobody is compelled to have the vaccine – it is a recommendation only

As we go into lockdown in NSW I will be doing Zoom appointments for all appointments.

Those women who need face to face appointments as well will have an additional quick visit to check BP and do a scan – please come alone.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update Friday 11 June 2021

COVID-19 Vaccine
On 9 June RANZCOG changed its recommendation regarding the COVID-19 vaccination for pregnant women in line with the new ATAGI guidelines

It is now recommended that women have the Pfizer vaccine in pregnancy.

The vaccine can be given at any stage of pregnancy.

The Astra Zeneca vaccine is not recommended, because of a very low risk of life-threatening blood clots.

At this stage there is no specific hub for vaccination of pregnant women, in most cases you best option is to speak to your family doctor.

There is a hub at Homebush, where the vaccine may be available, but at this stage there is no specific advice on how and where you can be vaccinated.

I am hoping that further details will be available next week, and will advise accordingly.

The number of community-acquired cases in Australia, especially outside Victoria, remains very low, so the background risk from COVID-19 remains low.

You are perfectly entitled not to have the vaccine, however it is now considered that the benefits overall outweigh any risks.

Stay safe and I will issue a further update next week.

Rahul Sen

COVID-19 Update – Monday 3 August 2020

There are still no active cases at either RHW or POWPH.

This is the current advice from the Executive at Prince of Wales Private Hospital:

Signing in at the nurses station:
This is a general reminder that when you are in the Maternity Unit, can you please sign in and out at the nurses station. This is important should we be required to do any contact tracing.

Given the current local transmission of COVID-19 NSW Health has escalated the level of risk to moderate risk (Amber).

This requires all health workers wear a surgical mask if they are within 1.5m of patients, i.e. if appropriate social distancing cannot be maintained.

The new advice also recommends that patients may be required to wear a mask when outside of their room, i.e. when travelling through common areas. Accordingly, we will be requiring our patients to wear masks in such areas where reasonable and it won’t have an adverse effect on patient health. We will not be requiring patients to wear masks in their room.  Masks will also be considered for at-risk patients in shared rooms.

This advice came into effect on Friday 24 July 2020.

The new advice on mask use is underpinned by expert risk assessments and are summarised in the attached poster.

I would be grateful if you could convey these new requirements to your patients when discussing their admission to our hospital. We will also ensure patients are briefed on the new guidelines upon being admitted.

Rest assured that we will continue to practice all existing infection control protocols such as hand hygiene and physical distancing. We are continuously monitoring the evolving situation and will update advice as new evidence emerges and risk levels change.

Advice regarding the Special Care Nursery:

As of midnight 29 July 2020, due to the escalation of COVID-19 in Sydney, particularly with nearby hotspots of COVID-19, we are going to reinstate our visiting restrictions to our Special Care Nursery to be for mothers only.

The following is a link to the advice issued on 31 July 2020 UK College of O&G:

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

Nobody knows where we are heading in relation to COVID-19 infections in NSW. One thing is for sure we are less in control than we were one month ago.  This is not going to go away any time soon.  I doubt we will have an effective vaccine before next year and we may never have one.

My advice is that in addition to social distancing and meticulous hand hygiene women take extra precautions in the third trimester. I would recommend working from home wherever possible and avoidance of public transport.  I would avoid enclosed spaces with groups of people.

It is hard to know when you might go into labour and therefore when your last two weeks before labour will be, but as a precaution I would recommend you home isolate from 37 weeks onwards.

At present partners can come and go in both hospitals.  No other family members are allowed. There is a temperature check and risk screening check at the entrance and verbally on the phone before you come into hospital. Further restrictions are likely if COVID-19 numbers escalate locally.

As ever please stay safe.

Rahul

COVID-19 Update – Monday 20 July 2020

Changes to visitor policy

In light of these recent COVID-19 outbreaks, we have decided to make changes to our visitor policy at Prince of Wales Private Hospital. As a safety precaution, we are encouraging visitors to reconsider their need to visit, so we can minimise any potential infection risks to you or our staff. Our visitor policy now only permits patients to have one visitor, for one hour, once a day. Visitors should be from immediate family and they must not be unwell. This decision has been made to reduce the amount of people overall entering our hospital to keep our patients, staff and doctors as safe as possible.

In our obstetrics ward, visitors will be limited to the partner, though with no restrictions on timing or duration of visit.

We will be communicating the new visitor policy through our website, within the hospital, and directly with patients upon admission.
NSW Health are providing regular COVID-19 updates, you can follow these at: https://www.health.nsw.gov.au/news/Pages/20200713_01.aspx

Elective surgery continuing as normal

Despite this precautionary change, please be assured that we are continuing to perform elective surgery as normal at this time. A comprehensive set of measures are in place to minimise the risk of exposure to COVID-19 by patients, staff and doctors.

We understand that some patients will be disappointed at this visitor policy change, however we would ask for your support in reassuring patients that we are taking this step to ensure their safety. Thanks again for your understanding and support, and please reach out if you have any queries or concerns.

Further restrictions are likely if COVID-19 numbers escalate locally.

As ever please stay safe.

Rahul

COVID-19 Update – Friday 17 July 2020

We are now entering the second wave of COVID-19 in Australia.

The problem with this wave is that, unlike the first wave, when we could “turn off the tap” by restricting visitors from overseas and put them in hotel quarantine, the NSW cases this week have been mainly local transmission, and therefore not in quarantine and so not able to be identified, located and isolated.

At the moment it is business as usual in the hospital. Elective surgery is back at 100%. The COVID screening on the wards has been reduced. The lifts still take an age.
We have no cases of COVID-19 in the hospital.

The cord blood donation programme has re-commenced this week, earlier than previously expected.
In my practice 3D scans are re-starting from this Saturday 18th July. I am also doing catch up clinics on Saturdays in July for women who were put on a waiting list in March, April and May.

But there are signs that things a heading backwards. I do not know how things will turn out in the next few days and weeks. I am concerned that we will be returning to how things were in April, when we were preparing for the first wave.

The hospital has started to reintroduce restrictions on visitors. The restrictions will be scaled up or down according to perceived risk.
At the moment meticulous hand hygiene and social distancing will suffice. I would continue to work from home and avoid public transport. If things go backwards please be ready to take extra precautions.

In term of my practice I will continue to see everyone face to face until there is widespread community transmission and then I will have to return to Zoom appointments with brief face to face for the purposes of checking blood pressure and performing an ultrasound.

In the meantime it remains my priority to look after you during the pregnancy and be there for your birth. I have no leave planned for the remainder of the year. I may take a few days off in October and again in December. Having been in the hospital every day since 6 January I think that’s OK.

As ever please stay safe.

Rahul

For those interested in CPR for babies the following may be of interest:

Website: www.cprkids.com.au or email: hello@cprkids.com.au or Tel: 1300 543 727

Sydney Children’s Hospital also provides excellent emergency care for babies.
Emergency First Aid for Baby: www.littlelives.com.au

COVID-19 Update – Friday 3 July 2020

The increase in COVID-19 cases from Melbourne is a great concern.

It is a reminder that we need to remain vigilant. COVID-19 has not gone away. Nor is it going to. On the positive side, the NSW cases seem to be almost exclusively from overseas and currently in quarantine.

Social distancing is being observed and a highly variable manner. I would still avoid large crowds and enclosed spaces.

Open air spaces remain fine, especially when the weather is good.

I still recommend working from home for both you and your partner wherever possible and avoidance of public transport.

I am very careful about children in my practice. This is not because of risk of COVID-19 – children are likely a very low risk of transmission. It is because of risk of respiratory symptoms and risk to me of symptoms – children are frequent carriers of rhinovirus.

I develop flu-like symptoms I have to close my practice and cannot attend the hospital. That is why I am being very careful. It means I maximize the chance I am there when you need me.

For that reason please do not bring children into the practice. I know this is a shame – I usually love to see babies, especially babies I have delivered.

I am re-starting 3D scans on alternate Saturdays from 17 July

If you are 34 weeks or less on 17 July then book in with Peta for a 3D scan.

If you are already over 34 weeks then we will continue to do your 3D scan with your 36 week growth and wellbeing scan.

My secretary, Peta, has a lunch break between 12.30 and 1, so if the phone is not answered during that time please leave a message and she will get back to you as soon as possible.

I continue to work out of the Edgecliff rooms only. I am still using plastic chairs and disposable sheets. I still ask that you either come alone or bring just your partner.

Masks are provided at the entrance.

As ever please stay safe.

Rahul

COVID-19 Update – Monday 22 June 2020

The main news is a relaxation of restriction on visitors at POWPH, as follows:

Maternity Visiting Hours: 1600-1900 One nominated visitor for the duration of admission for up to two hours. (partner or support person is able to visit at any time).

Maternity Visiting Hours for siblings: 1600-1800 – One sibling per day and visit not to coincide with nominated visitor.

There have still been no COVID cases so far at RHW or POWPH.

The stability in number of cases in NSW is cause for optimism. But, we still need to be cautious – the effect of relaxation of restrictions can take 2-3 weeks to result in an increase in new cases.

Overall, I remain quietly optimistic but stress that we need to maintain vigilance. It is good that things are starting to re-open, but I am mindful of the fact that you cannot control other people’s behaviour and enclosed spaces, crowded events and close proximity remains a risk.

The situation in Victoria reminds us that new cases can increase without warning. The situation in Singapore reminds us that the situation can be difficult to contact once control is lost.

The hospital is now very busy again. Elective surgery will return to normal in July.

The wait times for the lifts at are now very long as only four people are allowed in the lift at one time

There are still screening measures in place at the entrance to the hospital and by phone for all planned admissions

If anyone has missed out on the Zoom classes or cannot get access to the video please contact Tracey Hayden at the following email address: traceyhayden@healthscope.com.au

I am continuing to advise all pregnant women and their partners to work from home where possible.

Where working from home is not possible, at least avoid public transport.

The usual principles of social distancing and regular, thorough hand hygiene continue to apply.

If you are concerned about the risk to you from travel or your work place please discuss with me so that we can do an assessment and make a recommendation to your work.

I continue to work out of the Edgecliff rooms only. I am still using plastic chairs and disposable sheets. I still ask that you either come alone or bring just your partner.

Masks are provided at the entrance.

As ever please stay safe.

Rahul

COVID-19 Update – 27 April 2020

Last week we had a woman with suspected COVID in maternity, who needed a caesarean section in labour and as the consultant on call I had to do an emergency in full PPE. Everything went very smoothly and mother and baby were both fine. It turned out later she did not have COVID but there were some important learning points.

One is that infections in pregnancy, especially urinary tract infections, should be promptly and adequately treated and a repeat urine test performed after a course of antibiotics as test of cure. That could save you being treated as suspected COVID positive when you are not.

The consequences of being treated as COVID positive or suspected COVID positive are that your partner cannot be present for the caesarean, your baby is taken away and monitored at birth, and everyone in theatre is in full PPE. We might have a low threshold for calling emergency caesarean in labour, knowing that the process of getting prepared takes an hour longer than usual, and we do not want to be doing that when your baby is distressed.

We have so far still had no COVID positive women in either RHW or POWPH.

I am moving house on Wednesday. I will not be available for any routine appointments. My colleagues in the group if necessary.

In the event of an emergency, as ever, please contact delivery suite at the hospital where you are booked.

For POWPH that is: 9650 4444

For RHW that is 9382 6100 or the triage phone: 0439 869 035

An observation about life on the postnatal ward is that the restriction on visitors has actually been a tremendous asset to women coming to terms with breastfeeding and life as a new mum.

I personally feel that partners should be able to come and go from maternity, but be asked to minimise their coming and going. The reason for the policy is that asymptomatic carriers still represent the greatest risk to women and staff, including doctors, but it would be nice if some discretion could be exercised.

In my rooms I ask that partners and other children not attend the face to face appointments, however I do make some exceptions, when the benefits outweigh the risks. For example for the first ever view of the baby’s heart beat, or when there is an unexpected finding of a pregnancy that is not progressing.

In the meantime, it continues to be largely business as usual.

As ever, please stay safe.

Rahul

 

COVID-19 Update – 24 April 2020

The great news from Australia is, of course, that our numbers remain very low and the trend remains down.
We have so far had no COVID positive women in either RHW or POWPH.

There are screening systems in place, both questions on arrival and temperature checks, in both hospitals. You may need to go through both, depending on which entrance you use.

We have done many, many drills and rehearsals, and we have PPE, so we feel well equipped to look after you, even if you are seriously unwell. Currently that looks unlikely.

There are signs of relaxation on restrictions, including elective surgery and some beaches.

BUT

The situation can change.

We know from Japan and Singapore, where the curve had flattened that new cases are increasing rapidly again. If we get it wrong here the same will happen. If the same happens here there will then need to be a tightening of restrictions again.

The current policy of no visitors applies to both RHW and POWPH.

Partners at both RHW and POWH are encouraged to be present for birth. It is unlikely that will change. At present partners are allowed to come and go at RHW. Partners at POWPH not allowed to go and return, once they have come in for the birth.

Most of you are working from home already and being very careful about outside contact. That should continue.

Many are asking about child care and pre-school. In the current environment it would seem reasonable to send young children back to pre-school. I would recommend keeping them home for two weeks prior to expected delivery date, bearing in mind that nobody knows exactly when you will give birth, and every strategy has inherent risks.

The new strategy for diabetes screening is popular and working well.

The greatest risk by far to everyone comes from asymptomatic carriers. I ask, therefore, that when you attend the face to face appointment you attend alone, without partners or children. Remember I will ALWAYS so you for an appointment if you need one urgently.

I am continuing to do my best to stay well and to protect myself and my staff, so that I can be there when you need me.

My planned leave in September/October has been cancelled. I don’t think anyone is going on an overseas holiday for a while. I might do something short locally instead.

As every please stay safe.

 

COVID-19 Update – 17 April 2020

Things continue to be very stable on the hospital front. There have been no COVID positive patients at POWPH. Services are in no way stretched. The new cases in Australia is static and low.

However. Things can change. It remains likely that there will be second wave. We feel confident that the government’s message of social distancing, the closure of beaches, bars and businesses has so far contained the pandemic locally, but will clearly have far-reaching social and economic impacts.

It should be borne in mind that the second wave of infection will come from cases already in Australia. The big risk is asymptomatic carriers, that is people who have few symptoms or none at all yet carry the infection.

That is the reason why the hospitals are restricting access to everyone, especially ICU and maternity.

That is the reason why I try to do all of the discussion by Zoom and have a brief face to face consultation to check blood pressure and do a scan to check the baby.

You can have a scan after every Zoom meeting if you wish. Some women want and need more. Some want and need fewer face to face visits.

For your face to face visits I request that anybody coming into the practice wear a face mask. I have some face masks inside the door if you do not have one. To minimise time spent in the office please make all appointments and payments by phone. Ideally please ask partners and any other family members to wait outside. The face to face visits are usually no more than 10 minutes.

There is generally plenty of time for discussion under the new arrangements, as the combination of a Zoom and face to face appointment is 25-30 minutes, compared with the previous standard 15 minute appointment.

Antenatal classes with Jenni and Rochelle are working well at POWPH. RHW is providing on-line classes.

In many respects it is business as usual in both hospitals. We are continuing to undertake many drills and training exercises. Some of these cut across consulting times, occasionally at short notice. I apologise for any inconvenience, however these are multidisciplinary training sessions, and you will appreciate that these are unusual times and if you are the on in need you would want us to be well rehearsed and efficient.

Please be reassured that pregnant women and their babies continue to be very well looked after, and the hospital environment at present remains a very safe one.

I attach a copy of the maternity FAQs from POWPH

Rahul

 

COVID-19 Update – 2 April 2020

We continue to be in a state of readiness.

We know from USA and Europe that partners who seem well but are “silent carriers” of COVID-19 infection are a major cause of transmission, so we are taking strict precautions around partners in hospital.

There are NO plans to exclude partners from birth, unless they themselves have symptoms or known infection, and partners are encouraged to stay and room in on the postnatal ward.  The rooms are small for 2 and ½ people, but very manageable for 4 or 5 nights.

If you are unwell and in labour we will care for you.  Please let us know BEFORE you come in, as the preparations required are extensive.

Women who have active COVID infection in labour do not need to be transferred.  An epidural early in the active phase of labour (after 3-4cm dilation) is recommended to minimise the chance of needing a general anaesthetic, which should be avoided for everyone’s sake for safety reasons.

You cannot have any visitors, not meet them in the coffee shop, nor receive takeaway food

We are trying to minimise risk to everyone.  I am trying to stay well so that I can be there when you need me.

Rest assured I am very well.  I am doing my best to stay well, which also involves trying to ensure that I have at least one day per week of no planned work.  I continue to do post-natal war rounds as usual.

If I need to quarantine for any reason, my team will back me up.  If we are all down then other teams will back us up.

Flu Vaccine:

I have now changed my advice regarding Flu vaccine.  Previously I advocated getting it done later in the season.  Now I recommend getting it done as soon as possible.  The new vaccine is available.  Perhaps the best place to get it is one of the big chemists, where you can book an appointment and avoid waiting and crowds of sick people.

Please bear with us when we try to book inductions.  Maternity units everywhere, ours included have been inundated with requests for induction of labour.  I am happy to book it any time after 39 weeks, but please be patient – few women are getting their first preference and, quite appropriately, we give priority to women with medical need.

The latest Royal College of Obstetricians (UK) information booklet can be found here: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-28-covid19-pregnancy-guidance.pdf

Medicare has approved a number of teleheath rebates.  I will draw up a list of fees, based on what type of appointment you have. If you have two appointments in one week, ie one Zoom appointment and one face to face appointment, you will only pay for one appointment.

I will provide another update next week

Stay safe

Rahul

 

Advice on COVID 19 for Pregnant Women

COVID 19 (or SARS CoV2) will soon become a major medical threat in Australia
The people most at risk are the elderly and the immune-compromised.
It does not appear to affect pregnant women or their babies any more than the background population
Mainly it will disrupt group activities, business, transport and work

The advice changes almost daily. Please see current advice from:

RCOG:https://www.rcog.org.uk/globalassets/documents/guidelines/coronavirus-covid-19-infection-in-pregnancy-v2-20-03-13.pdf
RANZCOG: https://ranzcog.edu.au/news/advice-to-obstetricians-and-gynaecologists,-gp-obs
The AMA: https://ama.com.au/article/update-novel-coronavirus-covid-19
NSWGovernment:https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx

My key advice is:

  1. Travel:

Do not undertake any overseas travel
Advise partners not to undertake overseas travel
Advise close family members not to undertake overseas travel if they wish to spend time with you or your baby after the birth

  1. Group Activities:

Avoid public transport and work from home where possible. Consider wearing a face mask where public transport cannot be avoided.
Do not attend group teaching, sporting or social activities
Keep 1.5m away from other people (social distancing)

  1. Hygiene:

Observe meticulous hygiene, especially of hands, at all times.  Soap and water or alcohol-based hand rub is acceptable.
Be particularly careful of touching eyes, nose and mouth
Be meticulous with hygiene around food preparation, eating and drinking

  1. Fever Clinic:

If you have fever (38ºC or above) and either cough or a flu-like illness you should attend the fever clinic at Prince of Wales Hospital, for nose and throat swabs Ring: 0409 172 311

 

COVID-19 Update – 30 March 2020

There has been a steady increase in COVID cases in NSW, as there has been in Australia as a whole.  The preparations are extensive.  Our ICUs stand ready.  This has not been a problem in pregnancy so far.

Plans are being made to screen all people who come on to the Randwick campus.  This is currently with temperature check but will be by thermal imaging in due course

Anyone with fever, cough, shortness of breath or flu-like symptoms should AVOID coming into the hospital or into my consulting rooms. Ring the fever phone on 0409 172 311 and see whether you need to attend the fever clinic for swab testing and self-isolate as required.

If you have the above symptoms and are in labour you need to come to hospital.  Please ring us first so that we can plan for your arrival. We have plans in place and have rehearsed drills to keep everyone as safe as we can.

I am in the process of updating all the pregnancy information.  I will send updates as they are available.

I have updated the schedule of visits and the diabetes screening.

My midwife appointments will be via phone, WhatsApp, Zoom or Skype.  Just text my midwife, Michele to arrange on 0417 821 438

All face to face appointments and scans with me from now on are in my Edgecliff rooms.

Parking: for the best place to park drive along New Mclean Street past the Aldi car park to the Eastpoint Food Fair car park.  Park on Level 2 (yellow), go through the glass doors and take the Resident Only lifts to level 5.

The Zoom online appointments have replaced all discussions but I will always see you as well if you want or need to be seen.

Otherwise, please stay indoors as much as possible.

It is safe and healthy to go for walks at least once a day, but avoid crowds and enclosed spaces.

There MAY be a benefit in wearing a surgical mask when you leave your home.

Stay safe

Rahul

 

COVID-19 Update – 24 March 2020

Please be reassured that healthy pregnant women and their babies are not more at risk than any other young, healthy people.  You will almost certainly be exposed and many/most of you will become infected.  You will have a mild, flu-like illness and recover.

After the elderly health care workers are most at risk, both of serious illness and worse.

If we are exposed or suspected of COVID infection we will need to quarantine for 14 days.  That will compromise our ability to provide pregnancy care.

Clearly I cannot come in for births if I am in quarantine.

As both a health care worker and employer I am making the following changes to my practice, in line with current recommendations

Please be aware that the landscape is evolving daily and that further changes are likely

From Wednesday 25 March the following changes will take effect:

There will be no face to face appointments for:

  • Gynaecology, including Pap smears and pregnancy planning
  • Postnatal checks

The antenatal appointments will be replaced by a combination of online Zoom appointments and very brief face to face meetings for the purpose of clinical examination.

Please make sure you have Zoom downloaded on your phone or computer: Please sign up to Zoom prior to your appointment using the email you provided to us. Dr Sen will send you a meeting invite for this appointment (please check junk mail) this email will have all links and meeting ID/Passwords you require.

https://zoom.us/

At the Zoom appointment we will together determine the need for a face to face physical assessment.  You will ALWAYS have the opportunity to see me (briefly) for a face to face meeting and scan – provided I am not in quarantine, which is why I am trying to stay well.

If a face to face appointment is required it must be under the following conditions:

  • No more than 5 minutes face to face time
  • Both you and me to wear a face mask
  • Visits will be spaced so that you do not meet other women in the waiting room
  • NOBODY else is to attend that visit – no other children, no partners, no family members

Clearly the assessment of the baby can only be done at face to face appointments.

The masks are because I am examining you physically and so clearly well under the 1.5-2m social distancing limit

In terms of costs.  I have not yet costed the Zoom appointments.  Wherever you have a Zoom and face to face appointment in the same week you will not be billed for both.

Please help make this run as smoothly as possible

We will get though this

Rahul

 

COVID-19 Update – 23 March 2020

As you can imagine there is widespread discussion about many aspects of how COVID-19 will affect us.  The effects will be profound

Please be reassured that healthy pregnant women and their babies are not more at risk than any other young, healthy people.  You will almost certainly be exposed and most of you will become infected.  You will have a flu-like illness and recover.

After the elderly health care workers are most at risk, both of serious illness and worse.

If we are exposed or suspected of COVID infection we will need to quarantine for 14 days.  That will compromise our ability to provide pregnancy care.

Clearly I cannot come in for births if I am in quarantine.

As a health care worker and employer I am making the following changes to my practice, in line with current recommendations

Please be aware that the landscape is evolving daily and that further changes are likely

From Wednesday 25 March the following changes will take effect:

There will be no face to face appointments for:

  • Gynaecology, including Pap smears and pregnancy planning
  • Postnatal checks

The antenatal appointments will be replaced by an online Zoom appointment.

Please make sure you have Zoom downloaded on your phone or computer.

At that appointment I will determine the need for a face to face physical assessment.

If a face to face appointment is required it must be under the following conditions:

  • No more than 5 minutes face to face time
  • Both you and me to wear a face mask
  • Visits will be spaced so that you do not meet other women in the waiting room
  • NOBODY else is to attend that visit – no other children, no partners, no family members

The reason for the appointment is that clearly the assessment of the baby can only be done in person.

The masks are because I am examining you physically and so clearly well under the 1.5-2m social distancing limit

Please help make this run as smoothly as possible

We will get through this

Rahul