BACKGROUND AND PURPOSE:

• Vintzileos et al. (AJOG, 2020) report on their experience with universal COVID-19 screening on labor and delivery and the accuracy of SARS-CoV-2 testing based on symptoms alone

METHODS:

• Retrospective cohort study (March 30 to April 12, 2020)
• Setting
  • New York area hospital system
• Participants
  • All obstetric patients admitted to L&D
• Study design
  • Symptomatic if ≥1 of the following: Fever | Cough | Shortness of breath
  • Testing: All patients tested for SARS-CoV-2 using RT-PCR on nasopharyngeal swabs
  • Newborns: Viral testing was performed on all neonates born to SARS-CoV-2 positive mothers

RESULTS:

• 161 patients
  • Mean age: 31 years (range 15 to 42)
• Demographics
  • 47.2% Caucasian | 23.0% Hispanic | 16.8% African-American | 13.0% Asian/Indian
• SARS-CoV-2 positive rate: 19.9%
  • Symptomatic positive: 34% (11 patients)
  • Asymptomatic positive: 66% (21 patients)
• Performance of maternal symptoms as a screening test to predict COVID-19 infection
  • Sensitivity: 34.4% (11/32)
  • Specificity: 96.1% (124/129)
  • Positive predictive value: 68.7% (11/16)
  • Negative predicative value: 85.5% (124/145)
• Knowledge of asymptomatic COVID-19 positive patients would increase PPE use by 10%
• Neonatal outcomes
  • All neonates born to COVID-19 positive mothers tested negative for the virus

CONCLUSION:

• In this study, 20% of women presenting to L&D were positive for COVID-19
  • 66% of these women were asymptomatic
  • No neonates born to positive mothers tested positive
• The authors make the following points based on these results

This approach ensures that SARS-CoV-2 positive mothers are accurately identified and triaged

Clinicians can monitor for the development of symptoms while these patients are admitted and allocate inpatient resources appropriately (chest imaging, supplemental oxygen, infectious disease consults) if a mother’s respiratory status changes secondary to COVID-19

On a system level, identifying COVID-19 positive mothers has a significant impact on rooming postpartum patients with/near one another and in ensuring the safe transfer between hospital units

Learn More – Primary Sources:

Screening all pregnant women admitted to Labor and Delivery for the virus responsible for COVID-19

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