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MINISTRY OF
HEALTH
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SOCIALIST
REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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No. 775/QD-BYT
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Hanoi, March 28,
2022
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DECISION
GUIDELINES
ON CARE AND MANAGEMENT FOR PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS
INFECTED WITH COVID-19 AT HOME
MINISTER OF HEALTH
Pursuant to Law on Prevention and Control of
Infectious Diseases in 2007;
Pursuant to the Law on Medical Examination and
Treatment in 2009;
Pursuant to Decree No. 75/2017/ND-CP dated June
20, 2017 of Government on functions, tasks, powers, and organizational
structure of Ministry of Health;
At request of Director of Department of Maternal
Health and Children, Ministry of Health,
HEREBY DECIDES:
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Article 2. This Decision comes into effect from the day of signing.
Article 3. Department of Maternal Health and Children; Chief Ministry
Office; Chief Ministry Inspectorates; directors and general directors of
departments, general departments affiliated to Ministry of Health; directors of
Health Departments of provinces and central-affiliated cities; heads of medical
entities and heads of relevant entities are responsible for implementation of
this Decree./.
PP. MINISTER
DEPUTY MINISTER
Nguyen Truong Son
GUIDELINES
CARE
AND MANAGEMENT FOR PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH
COVID-19 AT HOME
Attached to Decision No. 775/QD-BYT, dated March 28, 2022 of Minister of
Health
I. OBJECTIVES AND REGULATED
ENTITIES
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The “Guidelines on care and management for pregnant
women, lactating women, and infants infected with COVID-19 at home”
(hereinafter referred to as “Guidelines”) are developed in order to provide
pregnant women, lactating women, and infants with mild SARS-CoV-2 infection
with guidelines on specific management and care at home.
Care and management of pregnant women, lactating
women, and infants infected with COVID-19 at home shall comply with “Guidelines
on management of COVID-19 patients at home” (attached to Decision No.
604/QD-BYT dated March 14, 2022 of Minister of Health), amended documents (if
any), and these Guidelines.
2. Regulated entities
a) Medical stations of communes, wards, town-level
wards; mobile medical stations; medical centers of districts and clinics;
emergency transport centers and facilities assigned to manage pregnant women,
lactating women, and infants infected with COVID-19 at home;
b) Health workers and individuals managing pregnant
women, lactating women, and infants infected with COVID-19 at home.
c) Pregnant women, lactating women, and infants
infected with COVID-19 and their caregivers at home.
II. ELIGIBILITY OF PREGNANT
WOMEN, LACTATING WOMEN, AND INFANTS INFECTED WITH COVID-19 FOR RECEIVING CARE
AT HOME
Adopt criteria under Section 2 of the “Guidelines
on management of COVID-19 patients at home”, and:
1. For pregnant women
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- Do not have any of the following signs:
+ Constant and/or growing stomachache;
+ Vaginal bleeding;
+ Watery discharge;
+ Loss of consciousness or convulsion;
+ Swelling of face and limbs;
+ Headache, blurred vision;
+ No fetal movement (for pregnancy older than 20
weeks) or weak fetal movement;
+ Any other irregularity.
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- Have no or mild clinical symptoms;
- Do not have any of the following signs:
+ Reduced nursing or breast refusal;
+ Hypersomnia;
+ Respiratory failure: respiration rate > 60
times/minute at 2 separate counts, agonal breathing, wheezing, flaring nostrils,
chest retraction, episodes of stopped breathing longer than 20 seconds, SpO2
< 96%;
+ Convulsion or loss of mobility; irregular
movement;
+ Body temperature: Fever exceeds 38 oC
and does not reduce after taking antipyretic or after 48 hours; body temperature
drops below 36 oC after warming up;
+ Redness, swelling or discharge of the eyes;
redness, swelling or discharge of belly buttons;
+ Dehydration: sunken eyes, chapped lips, wrinkling
skin, decreased urine output;
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+ Digestion: Constant vomiting, abdominal bloating,
blood in stool;
+ Other irregularity.
III. GUIDELINES ON MONITORING
AND PROVIDING CARE FOR HEALTH OF PREGNANT WOMEN, LACTATING WOMEN, AND INFANTS
INFECTED WITH COVID-19 AT HOME
Prepare medicine and other supplies in accordance
with Section 4 of the “Guidelines on management for COVID-19 patients at home”.
Implement routine care for pregnant women,
postnatal women, lactating women, and infants in accordance with “National
guidelines on Reproductive Health care services” (attached to Decision No.
4128/QD-BYT dated July 29, 2016 of Minister of Health) and take into account
the following:
1. For pregnant women
1.1. Health monitor:
- Take body temperature reading at least twice a
day in the morning, in the evening and when experiencing any irregularity.
Count breathing rate, pulse, measure SpO2 and blood pressure (if
possible) on a daily basis.
- Check for pregnancy-related signs: fetal
movement; any obstetric irregularity.
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1.2. Management and care during pregnancy
- Attend periodic antenatal care in accordance with
the National guidelines on Reproductive Health care services. In addition,
attend antenatal care whenever experiencing an irregularity or when indicated
by health workers;
- If a pregnant woman does not experience any
obstetric irregularity on the date of antenatal care, provide remote antenatal
care or advise waiting until expiration of isolation period;
- Have a healthy diet, do healthy exercises, supplement
micronutrients, refrain from smoking or come into contact with secondhand
smoking, refrain from using alcoholic beverages and other stimulants, addictive
substances;
- Maintain supplement of iron/folic acid or
multi-micronutrient tablets as instructed by health workers (stop immediately
after experiencing vomiting and/or diarrhea).
2. For women during postnatal periods and
lactating women
- Take body temperature reading at least twice a
day in the morning, in the evening and when experiencing any irregularity.
Count breathing rate, pulse, measure SpO2 and blood pressure (if
possible) on a daily basis.
- Monitor lochia, uterine contractions, and detect
any obstetric irregularity.
- Immediately inform health workers or receive a
checkup at medical facilities upon experiencing any irregularity under Section
5.1.3 of the “Guidelines on management of COVID-19 patients at home” or upon
experiencing any of the followings:
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+ Odor of lochia;
+ Violent abdominal pain or persistent and growing
abdominal pain;
+ Irregular lumps, increase in size, or abscess in
the perineum stitches (in case of vaginal delivery) or C-section scar;
+ Fever that exceeds 38 oC and does not
reduce after taking antipyretic or after 48 hours;
+ Swelling of face, limbs, or blurred vision, or
severe headache;
+ Convulsion;
+ Breasts: swelling, redness, tenderness, or nipple
discharge;
+ Any other irregularity.
3. For infants
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- Monitor general conditions of the infants:
nursing, skin tone, stool, and urine;
- Take body temperature reading at least twice a
day (regular body temperature of an infant ranges from 36,5 oC to
37,5 oC);
- Count breathing rate and measure SpO2 (if
equipped with pulse oximeter) twice a day;
Note: Pulse oximeter for use in
adults will not be accurate when used for infants, therefore, combine with
monitoring infants’ wellbeing signs.
- Immediately inform health workers or bring
infants to medical facilities as soon as the infants experience any dangerous
sign under Section 2, Part II hereof.
3.2. Basic care for infants
Frequent rapid antigen test or RT-PCR test is not
necessary for infants even when their caregivers are infected with COVID-19.
3.2.1. If a mother and her infant are infected
with COVID-19:
+ Maintain breastfeeding. If the infant experiences
stuffed nose and thus unable to sustain the breastfeeding, clean their nostrils
prior to breastfeeding.
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3.2.2. If only the mother is infected with
COVID-19: Advise the mother and her family to consider the benefits of
breastfeeding and risk of COVID-19 infection of the infants.
- In case the mother decides to breastfeed:
+ Wash hands regularly with soap and clean water or
hand washing liquid prior to feeding the infant and wear face masks whenever
staying close to the infant;
+ Wash breasts once per day during regular body
wash; if droplets land on breasts because the mother coughs or sneezes, wash
breasts with clean water and soap and immediately wipe dry;
+ If the infant is unable to sustain the feed,
instruct the mother to express breast milk manually (or with the use of an equipment)
and feed the infant using spoon and cup; wash hands regularly with clean water
and soap or hand washing liquid prior to expressing breast milk; wear face
masks while expressing milk and feeding the infant; cleaning expressing
equipment, extractor, and feeding equipment such as spoon and cup (it is best
to sterilize by steaming or soaking in boiling water);
- If the mother’s health deteriorates and she is
unable to continue breastfeeding: Utilize sterilized milk from mother's milk
bank (if any) or nurture the infant in accordance with guidance of health
workers. Assist the mother in nursing the infant as soon as her health
stabilizes.
IV. MEDICINE INSTRUCTIONS
1. For pregnant women and lactating women
- Antipyretic: use when body temperature exceeds
38,5 oC or severe headache, only use antipyretic which contains
simply Paracetamol (with dose intended for adults under Section 5.2 of the
“Guidelines on management of COVID-19 patients at home”).
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+ Cough: Use traditional methods such as lime,
honey, sodium chloride 0,9% mouthwash. Medicine containing Dextromethorphan,
Guaifenesin, etc. can be used as cough medicine or herbal cough medicine. Do
not use medicine contraindicated for pregnant women and lactating women;
+ Stuffed nose, runny nose: spray or drop sodium
chloride 0,9%;
+ Diarrhea: supplement with Oresol, zinc (10-20
mg/day).
- Continue using out-patient prescription drugs for
any underlying medical condition or according to physician's indications.
Note: Do not use antiviral drugs,
antibiotics, anti-inflammatory medicines for pregnant women, lactating women,
etc. without indications and prescription.
2. For infants
- Antipyretic: use when body temperature exceeds
38,5 oC. Use Paracetamol at a dose of 10-15 mg/kg/instance (oral
administration or rectal suppositories, and repeat after 4 - 6 hours if
necessary; total dose must not exceed 60 mg/kg/day. If infants vomit within 15
minutes after taking medicine, give the infants another dose;
- Stuffed nose: Drop 2-3 drops of sodium chloride
0,9% in each nostril when the infants experience stuffed nose and have
difficulty feeding. Warm the sodium chloride bottle in advance in this case.
Note:
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- Do not give infants antiviral drug,
antibiotics, anti-inflammatory medicines, etc. without indications and
prescription;
- Do not clear stuffed nose of infants using
spray.
V. TASKS OF MEDICAL STATIONS AND
FACILITIES THAT MANAGE TREATMENT AT HOME
1. Continue to manage pregnancy in accordance with
the National guidelines on Reproductive Health care services; manage
non-infectious diseases (gestational diabetes, hypertension, etc.) in pregnant
women;
2. Manage COVID-19 patients at home in accordance
with the “Guidelines on management of COVID-19 patients at home” attached to
Decision No. 604/QD-BYT dated March 14, 2022 of Minister of Health and amending
documents (if any);
3. Regularly maintain contact with pregnant women,
lactating women, and family of infants infected with COVID-19 receiving
treatment at home in order to give advice, mental support, and provide
interventions if necessary.
4. Inform the mothers and families about hospital
referral of pregnant women, postnatal women, and infants infected with COVID-19
in accordance with regulations of local governments.
5. Advise pregnant women, lactating women about
COVID-19 vaccination in accordance with guidelines of Ministry of Health.