Universal Rapid Testing for SARS-CoV-2 in Obstetrical Patients at a Suburban New York Tertiary Medical Center: Prevalence and Patient Characteristics

Research Article

Austin J Obstet Gynecol. 2021; 8(3): 1172.

Universal Rapid Testing for SARS-CoV-2 in Obstetrical Patients at a Suburban New York Tertiary Medical Center: Prevalence and Patient Characteristics

Li BS1*, Grimes CL3, Clare CA1,2 and Vicens-Villafana J1

1Department of Obstetrics and Gynecology, New York Medical College, USA

2Department of Obstetrics and Gynecology, New York City Health + Hospitals/Metropolitan, USA

3Departments of Obstetrics and Gynecology and Urology, New York Medical College, USA

*Corresponding author: Bernice S. Li, Department of Obstetrics and Gynecology, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA, Tel: (917)214- 1353, (212)423-6262/ (914) 594-2112; Fax: (914) 594- 2111; E-mail: Bernice.li@wmchealth.org

Received: February 23, 2021; Accepted: March 11, 2021; Published: March 18, 2021

Abstract

Objective: To report the rate of COVID-19 positive cases among pregnant patients presenting to labor and delivery, and to further characterize the asymptomatic positive patients. To compare the patient characteristics between the positive and negative groups.

Methods: We performed a retrospective review on pregnant patients who presented to labor and delivery from April 10 to June 10, 2020 at our suburban New York tertiary medical center after the institution of a universal COVID-19 screening policy. Demographic and clinical data from electronic medical records were collected.

Results: A total of 130 pregnant patients underwent COVID-19 testing with Polymerase Chain Reaction (PCR) nasopharyngeal swabs. 14.6% of women were positive at the time of presentation, and among those, 25% presented with COVID-19 symptoms. Among the 130 patients, the asymptomatic COVID-19 carrier rate was 14.4%. More patients in the COVID-19 positive group identified as Hispanic (65.2% vs. 32.5%) and were obese (39.1 % vs.18.7 %). There was no difference in overall maternal profiles including maternal age, gestational age, antepartum steroid use, smoking status. Delivery mode sand adverse obstetrical outcomes (risks of chorioamnionitis/endometritis, need for blood transfusion, or hypertensive disorder) were not different between groups. There was no reported maternal death or maternal intubation/ventilation in our study.

Conclusion: During the first two months of universal COVID-19 testing, most COVID-19 positive patients were asymptomatic throughout the hospital stay. Around one in seven asymptomatic patients tested positive on presentation. Obesity and Hispanic ethnicity were associated withCOVID-19 infection among this pregnant population.

Keywords: COVID-19; SARS-CoV-2; Coronavirus; Pregnancy; Obesity; Race; Ethnicity

Introduction

A novel coronavirus SARS-CoV-2 (COVID-19), first detected in Wuhan, China in December 2019, has been detected in millions of people worldwide. The United States now has the highest numbers of test-confirmed cases. Being the largest and most densely populated area in the US, New York remains an epicenter for the pandemic, with by far the largest outbreak in the nation with over 574,072 confirmed cases and 26,225 death as of this writing [1]. Since the announcement in March 2020 of the first containment zone in New Rochelle, located in Westchester County, New York, Westchester County has remained a “hotspot” with 45,335 positive cases and a 4.6% positive rate among all tested as of November 15th, 2020[1]. There were several small case-series with relatively short study periods [2-4] investigated the characteristics of COVID-19 positive pregnant patients at the earliest period of the pandemic, the disease course in pregnant patients, and the extent to which SARS-CoV-2 infection impacts pregnant women in a suburban region, remain an ongoing research area.

With the continuous growth of the disease rate globally and a sign of second wave of disease in New York State, we expected that more obstetrical patients were exposed to the novel virus with a large proportion of them being asymptomatic. Recent analysis has suggested that pregnant women with symptomatic infection were at increased risk for severe COVID-19 associated illness including intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death [5].

In order to have a better understanding of the population we are serving and the associations between SARS-CoV-2 infection and adverse pregnancy outcomes, we aimed to report the rate of COVID-19 positive patients and rate of asymptomatic positive patients presenting to labor and delivery after the institution of a universal screening policy. We further aimed to characterize the asymptomatic positive patients and to compare the patient characteristics between the positive and negative test groups.

Methods

This is a retrospective chart review of patients triaged or admitted to labor and delivery at Westchester Medical Center (WMC) between April 10th 2020 and June 10th 2020 who met criteria for COVID-19 testing based on a universal testing policy. WMC is a tertiary care referral center providing care in the Hudson Valley Region with about 1,200 deliveries and 300 maternal transfers annually. At WMC, universal Polymerase Chain Reactive (PCR) nasopharyngeal swab testing was implemented on April 10th, 2020. Universal testing policy required all pregnant persons to be screened for symptoms of COVID-19, and received the PCR nasopharyngeal test upon admission. This study was approved by Institutional review board from the New York Medical College (study ID 14274) and by the Clinical Research Institute at Westchester Medical Center.

Pregnant persons who presented to labor and delivery either with an obstetrical or medical complaint that warranted admission, triage patients who demonstrated COVID-19 symptomatology (fever/chill, muscle ache, upper respiratory symptoms, loss of smell/taste etc.) or were considered at risk per the institution’s infectious disease protocol, and antepartum patients who required prolonged inpatient management were included. Non-pregnant patients, pregnant patients presented to triage unit who did not require admission and showed no COVID-19 symptomatology with negative screening questionnaires, and patients who declined rapid COVID-19 testing were excluded from the study.

Continuous data was described with means and standard deviations or medians and ranges, depending on the distribution of data (parametric vs. nonparametric). Categorical data was described with rates/proportions. Parametric continuous data was compared with student t-tests and non-parametric data with a Mann-Whitney test. Proportions were compared with a chi-square or Fischer exact test. Statistical significance was defined as p<0.05. A power analysis was not performed as this was a retrospective study with a fixed sample size.

Results

Over a two-month period, a total of 130 pregnant patients underwent COVID-19testing with PCR nasopharyngeal swabs. 19 patients were tested positive (14.6%) at the time of presentation to WMC labor and delivery. There were four patients (3.1%) who had a history of positive COVID-19 test (two tested positive at an outside hospital and two tested positive prior to April 10th), then subsequently tested negative on presentation to WMC. Among these four patients, one person was tested COVID-19 positive again two weeks later as an antepartum inpatient.

Of the 20 patients positive for COVID-19 while inpatients (including the one antepartum patient who was positive on re-testing), five patients (25%) presented with COVID-19 symptoms. Of the 125 asymptomatic patients, 18 tested positive for COVID-19 (14.4%), and all remained symptom-free throughout their hospitalizations.

Overall, our patient population had a median age of 31 years (range19-46), and presented at a median gestational of 34 weeks (range 12 to 41 weeks). 40% of our patients self-identified as Hispanic, 29.3% as Black, 27.7% as White, with mean Body Mass Indices (BMIs) of 32. Most patients (96.9%) presented with an obstetric indication including labor, planned cesarean delivery, induction of labor and other pregnancy complications (Table 1).

Citation: Li BS, Grimes CL, Clare CA and Vicens-Villafana J. Universal Rapid Testing for SARS-CoV-2 in Obstetrical Patients at a Suburban New York Tertiary Medical Center: Prevalence and Patient Characteristics. Austin J Obstet Gynecol. 2021; 8(3): 1172.