PURPOSE:

• Many hospitals have implemented universal COVID-19 screening for all women admitted for delivery
• An NYC health system found a 13.5% prevalence of infection in asymptomatic women early in the pandemic
• Miller et al. (Obstetrics & Gynecology, 2020) examined the prevalence rates of infection with universal screening in Chicago

METHODS:

• Prospective case series
• Setting
  • Chicago hospital system (April 8 to April 27, 2020)
  • Acceleration phase of the pandemic
• Participants
  • Pregnant women
  • Admitted to the hospital for delivery
• Study design
  • Universal COVID-19 testing for delivery: Implemented April 8
  • Scheduled deliveries:  Tested 12 to 36 hours before admission 8 hour turnaround time
  • Unscheduled deliveries: Tested in triage | 2 hour turnaround time
  • All women asked about possible COVID-19 symptoms at time of admission
• Management protocols
  • Positive test: Managed in a dedicated COVID-19 unit
  • Asymptomatic: Managed on routine labor floor | Health care workers used PPE until the test result available
  • Patients and one allowed support person received procedure masks on arrival
  • Support persons screened for symptoms but not tested

RESULTS:

• Total of 635 pregnant
• Test results
  • Positive for SARS-CoV-2: 3.6% (23 women)
    • Positive but asymptomatic on presentation: 43.5% (10 women)
• Symptoms on presentation
  • Reported symptoms on presentation: 3.3% (21 women)
    • Positive for COVID-19: 61.9% (13 women)
  • Did not report symptoms on presentation: 96.7% (614 women)
    • Positive for COVID-19: 1.6% (10 women)

CONCLUSION:

• Symptoms alone did not reliably identify pregnant women with COVID-19 on admission to labor and delivery units
  • In this study, positive test rates were higher than those reported in the general population, leading the authors to suggest that infection rates in the general population, where testing is generally limited to symptomatic patients, may be higher
• Sutton et al. (NEJM, 2020) in a similar paper also found a much higher prevalence of infection with universal screening of pregnant women admitted for delivery in NYC
  • 215 pregnant women (all were screened)
  • Symptomatic: 1.9% | All were positive on testing
  • Asymptomatic women: 99.5% | 13.7% positive on testing
  • 87.9% of women had no symptoms of Covid-19 at presentation
• The authors in the NEJM paper conclude that

The potential benefits of a universal testing approach include the ability to use Covid-19 status to determine hospital isolation practices and bed assignments, inform neonatal care, and guide the use of personal protective equipment

Access to such clinical data provides an important opportunity to protect mothers, babies, and health care teams during these challenging times

Learn More – Primary Sources:

Clinical Implications of Universal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing in Pregnancy

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

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