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14 april 2020

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

April 14th 2020 https://www.nejm.org/doi/full/10.1056/NEJMc2009316

Report the prevalence of SARS-Cov-2 in women admitted for delivery in New York City


·        The obstetrical population have multiple interactions with the health care system and eventually most are admitted to the hospital for delivery.

·        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 were performed.

·        215 pregnant women delivered infants at the New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center; Four women (1.9%) had fever or other symptoms of Covid-19 on admission, and all 4 women tested positive for SARS-CoV-2 (Fig. 1).

·        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.

·        87.9% of SARS-Cov-2 positive patients 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).

·        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 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 personal protective equipment.