Universal Testing In Obstetrics Reveals A High Asymptomatic Carrier Rate For SARS-CoV-2

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Salient Points

The following article focuses on the increased risk of transmission of COVID-19 in pregnant females due to their increased interaction with the health care system.

It describes the need for universal testing among pregnant women, who are at risk of infectious diseases to ensure early diagnosis and containment of COVID-19 cases.                                    In the study conducted, among the 215 women who delivered, 1.9% had COVID-19 like symptoms at the time of admission to the delivery ward. All 4 women tested positive for COVID-19. In addition, almost all (99.5%) of the women with no signs or symptoms of the virus were tested with nasopharyngeal swabs; 29 of them tested positive for SARS-CoV-2.

The use of universal SARS-CoV-2 testing in all pregnant patients presenting for delivery revealed that at this point in the pandemic in New York City, most of the patients who were positive for SARS-CoV-2 at delivery were asymptomatic, and more than one of eight asymptomatic patients who were admitted to the labor and delivery unit were positive for SARS-CoV-2.

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

the use of PPE. Access to such clinical data provides an important opportunity to protect mothers, babies, and healthcare teams during these challenging times.

Detailed Summary

During this pandemic, these patients (Pregnant women) have multiple interactions with the health care system and eventually most are admitted to the hospital for delivery. The first case was diagnosed on March 13, 2020, these were two initially asymptomatic women in whom symptoms developed and who tested positive for SARS-CoV-2, after delivery. After these two cases were identified, universal testing was implemented with nasopharyngeal swabs and a quantitative PCR test to detect SARS-CoV-2 infection in women who were admitted for delivery.

Between March 22 and April 4, 2020, a total of 215 pregnant women delivered infants at the

New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center. All the

women were screened on admission for symptoms of Covid-19.

Four women (1.9%) had fever or other symptoms of Covid-19 on admission, and

all 4 women tested positive for SARS-CoV-2. Of the 211 women without symptoms,

all were afebrile on admission.

Nasopharyngeal swabs were obtained from 210 of the 211 women (99.5%) who did not have symptoms of Covid-19, of these women, 29 (13.7%) were positive for

SARS-CoV-2. Thus, 29 of the 33 patients who were positive for SARS-CoV-2 at admission (87.9%) had no symptoms of Covid-19 at presentation.

Of the 29 women who had been asymptomatic but who were positive for SARS-CoV-2 on admission, fever developed in 3 (10%) before postpartum discharge.

Two of these patients received antibiotics for presumed endomyometritis, and 1 patient was presumed to be febrile due to Covid-19 and received supportive care. One patient with a swab that was negative for SARS-CoV-2 on admission became symptomatic postpartum; repeat SARS-CoV-2 testing 3 days after the initial test was later positive.

The use of universal SARS-CoV-2 testing in all pregnant patients presenting for delivery revealed that at this point in the pandemic in New York City, most of the patients who were positive for SARS-CoV-2 at delivery were asymptomatic, and more than one of eight asymptomatic patients who were admitted to the labor and delivery unit were positive for SARS-CoV-2.

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.

The true prevalence of infection may be underreported because of false negative results of tests to detect SARS-CoV-2.

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 PPE. Access to such clinical data provides an important opportunity to protect mothers, babies, and healthcare teams during these challenging times.

 

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