Universal Screening: What Percent of Women Admitted to L&D are Positive for SARS-CoV-2?
Sutton et al. (NEJM, 2020) sought to determine how many pregnant women admitted for delivery were positive for SARS-CoV-2, based on a universal screening program initiated in New York City, a high prevalence COVID-19 ‘hot spot’
Retrospective review (March 22 and April 4, 2020)
2 Affiliated hospitals in New York City
All pregnant women admitted for delivery
All women screened at time of admission for COVID-19 using nasopharyngeal swabs (quantitative polymerase-chain-reaction)
215 pregnant women admitted to L&D
Symptomatic: 1.9% (n=4)
Positive for SARS-CoV-2: 100% (4/4)
Asymptomic: 98.1% (n=211)
99.5% screening (210/211)
Positive for SARS-CoV-2: 13.7% (n=29)
1 patient who was initially negative became symptomatic postpartum at which time repeat testing was positive
COVID-19 positive patients who were asymptomatic on admission
Percent of screen positive patients who were asymptomatic on admission: 87.9% (29/33)
Of those asymptomatic but COVID-19 positive
Median length of stay: 2 days
Fever developed in 10% (n=3) prior to postpartum discharge
Two patients received antibiotics for endomyometritis
1 patient received supportive care for COVID-19
Most patients admitted for delivery with COVID-19 were asymptomatic
Potential benefits of universal screening can help
Determine which patients will benefit from isolation practices
Direct bed assignments
Guide neonatal care and PPE use
The authors further state that
Although this prevalence has limited generalizability to geographic regions with lower rates of infection, it underscores the risk of Covid-19 among asymptomatic obstetrical patients
Moreover, the true prevalence of infection may be underreported because of false negative results of tests to detect SARS-CoV-2
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