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Esteemed Contributor
Posts: 6,779
Registered: ‎03-09-2010

Universal Testing of Obstetric Patients

Excerpt from New England Journal of Medicine:

 

In recent weeks, Covid-19 has rapidly spread throughout New York City. The obstetrical population presents a unique challenge during this pandemic, since these patients have multiple interactions with the health care system and eventually most are admitted to the hospital for delivery. We first diagnosed a case of Covid-19 in an obstetrical patient on March 13, 2020, and we previously reported our early experience with Covid-19 in pregnant women, including two initially asymptomatic women in whom symptoms developed and who tested positive for SARS-CoV-2, the virus that causes Covid-19, after delivery.1,2 After these two cases were identified, we implemented universal testing with nasopharyngeal swabs and a quantitative polymerase-chain-reaction 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 (Figure 1). 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 (median length of stay, 2 days). Two of these patients received antibiotics for presumed endomyometritis (although 1 patient did not have localizing symptoms), 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 positive.

 

Our 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. Moreover, the true prevalence of infection may be underreported because of false negative results of tests to detect SARS-CoV-2.3

 

More:  https://www.nejm.org/doi/full/10.1056/NEJMc2009316

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Honored Contributor
Posts: 14,171
Registered: ‎03-09-2010

Re: Universal Testing of Obstetric Patients

Those poor little babies

Stop being afraid of what could go wrong and start being positive what could go right.
Esteemed Contributor
Posts: 5,530
Registered: ‎03-30-2014

Re: Universal Testing of Obstetric Patients

I can't even imagine how horrible it must be have baby right now.  How much nerve would take to even do well baby visits?

Respected Contributor
Posts: 3,970
Registered: ‎03-16-2010

Re: Universal Testing of Obstetric Patients

@Marp, boy if this isn't a wake up call about how prevalent this virus is out there, I don't know what is.  Shake my head when I read "we only have 20 cases in my area". Well, only 20 have been identified. 

 

So for this study, out of 215 women presenting to the hospital, 211 of them had no symptoms of COVID-19 with 29 of them testing positive.  And while the study can't account for this, one can assume a good number of the expectant Mom's were being very careful and were concerned about contracting this disease while pregnant.  And then had no clue they actually had it when they presented to the hospital to have their baby.

 

Then 4 others did have mild symptoms.  So a total of 33 had COVID-19.

 

Interesting that they had a false negative result.  Glad she was in the hospital when she started with symptoms so they could retest her.


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Honored Contributor
Posts: 32,834
Registered: ‎03-10-2010

Re: Universal Testing of Obstetric Patients

Someone I know is a labor and delivery nurse.  A couple of weeks ago a couple and MIL came in because the woman was in labor.  She was tested automatically for Covid-19 and found to be positive. She had no symptoms at all.  They also tested the husband and he tested positive as well, again with no symptoms.  The husband had to leave the hospital and go into isolation, mom gave birth and had to go into isolation as well.  Neither of them were allowed to be with their newborn child. 

Respected Contributor
Posts: 3,970
Registered: ‎03-16-2010

Re: Universal Testing of Obstetric Patients

I saw an interview yesterday with a respiratory therapist in her late 20s  that was pregnant and started with a dry cough and low grade fever.  She had not been working due to the outbreak of cases in the area.

 

She tested positive and ended up in the hospital.  After 3 days her condition deteriorated to where she was moved to ICU and placed on a ventilator.  As a respiratory therapist she certainly knew what that meant.

 

They immediately put her in a medical coma and then the doctors consulted with the family as to what to do.  The medical team ultimately decided her best chance was to deliver the baby (34 weeks gestation) to give her lungs more room, etc.  Husband agreed.   The baby was okay, but sent to NICU.  Mom was kept in the coma for 10 days and ultimately weaned off the ventilator.  She said the doctor told her I didn't know wether we were going to have a baby or a funeral.  They were that close to losing her.

 

So at least this story had a happy ending.  Mom still hasn't been able to hold her baby yet, she still hasn't tested negative.  And has to have 2 negative tests before she can hold the baby.

 

 


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Esteemed Contributor
Posts: 7,962
Registered: ‎02-19-2014

Re: Universal Testing of Obstetric Patients


@pitdakota wrote:

I saw an interview yesterday with a respiratory therapist in her late 20s  that was pregnant and started with a dry cough and low grade fever.  She had not been working due to the outbreak of cases in the area.

 

She tested positive and ended up in the hospital.  After 3 days her condition deteriorated to where she was moved to ICU and placed on a ventilator.  As a respiratory therapist she certainly knew what that meant.

 

They immediately put her in a medical coma and then the doctors consulted with the family as to what to do.  The medical team ultimately decided her best chance was to deliver the baby (34 weeks gestation) to give her lungs more room, etc.  Husband agreed.   The baby was okay, but sent to NICU.  Mom was kept in the coma for 10 days and ultimately weaned off the ventilator.  She said the doctor told her I didn't know wether we were going to have a baby or a funeral.  They were that close to losing her.

 

So at least this story had a happy ending.  Mom still hasn't been able to hold her baby yet, she still hasn't tested negative.  And has to have 2 negative tests before she can hold the baby.

 

 


This is uplifting and also sobering. Many of the "Recovered" statistics have this sort of arduous story of a fight for survival behind them. This is an illness you really do not want to catch. It isn't a walk in the park for a huge portion of people who survive. Just having an alarmingly high fever, like seems to happen quite often, would be awful. If you've ever had one you'll know what I mean.

 

Until we get mass testing on demand, assume everyone is infected and asymptomatic. Which is why you should run screaming (okay maybe back away quietly) from anyone who goes maskless. And no activities with people who don't live with you that involve them getting close and breathing on you, even with a mask on.

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