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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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Latest Updates

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 2020UK 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 though this

Rahul