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Testing Pregnant Women For Covid-19 Upon Entering Hospital

testing pregnant women

In the past weeks, Covid-19 has swiftly spread throughout New York City. It is important to test all pregnant women for coronavirus and it should be mandatory upon entering the hospital. The obstetrical population gives a unique challenge during this outbreak since these patients have several interactions with health care specialists.

Eventually, most are admitted to the hospital for delivery. There was a case of Covid-19 on March 13, 2020, in an obstetrical patient. The hospital in NYC reported our first experience with Covid-19 in pregnant lady, including two initially asymptomatic women in whom symptoms appeared and who tested positive for COVID-19.

This virus causes Covid-19, after delivery. After both of these cases were known, the hospitals started performed extensive testing with nasopharyngeal swabs and quantitative polymerase-chain-reaction evaluation to detect SARS-CoV-2 disease in women who were admitted for delivery.

During March 22 and April 4, 2020, a total of 215 pregnant women delivered babies at the New York–Columbia University Irving Medical Center and Presbyterian Allen Hospital. Four women (1.9%) had a fever or other signs of Covid-19 on admission, and all four women tested positive for SARS-CoV-2.

Of the 211 women without any signs, all didn’t have a fever on admission. Nasopharyngeal swabs were taken from 210 of the 211 women (99.5%) who didn’t have symptoms of Covid-19; of those ladies, 29 (13.7%) were tested positive for SARS-CoV-2. Hence, 29 of the 33 patients who were tested positive for COVID-19 at the admission (87.9%) had no signs of Covid-19 at the presentation.

Of the 29 women who didn’t have any symptoms but tested positive for SARS-CoV-2 on admission, fever happened in 3(10%) before postpartum discharge(median length of stay, two days). Two of the patients received antibiotics for presumed endometritis (although one patient didn’t have localizing symptoms), and one patient that was negative for COVID-19 on admission became postpartum for symptoms; repeat SARS-CoV-2 testing 3 days after the first test was positive.

Our use of extensive SARS-CoV-2 testing in all pregnant women ready for delivery showed at this stage in the pandemic in NYC, the many patients that were positive for COVID-19 at birth didn’t have symptoms, and at least one of eight asymptomatic patients that had been admitted to the labor unit was positive for SARS-CoV-2.

However, this prevalence has confined generalizability to geographic areas with lower rates of infection, it emphasizes the uncertainty of Covid-19 among asymptomatic obstetrical patients. Additionally, the true pervasiveness of disease maybe didn’t report due to false-negative results of tests to detect SARS-CoV-2.

The potential advantages of a testing approach include the ability to utilize Covid-19 to define hospital isolation methods and inform neonatal care and guide the use of personal protective equipment. Access to such clinical data presents an extraordinary opportunity to protect mothers, babies, and health care workers during these difficult times.

Hospitals In Greater Boston Started Universal Testing For COVID-19

Major hospitals throughout Greater Boston have a new admissions step which is a coronavirus test for patients who come in early labor.  Most clinics already had its employees meet pregnant ladies and some trans men at the entrance before then leading those with symptoms to isolation chambers.

Presently, a diagnostic nasopharyngeal swab is part of admissions for all patients admitted for labor— whether they have symptoms of COVID-19 or not — at many of the state’s biggest maternity care facilities.

Boston Medical Center began extensive testing mid-April for women delivering a baby. Tufts Medical Center started the same process as well. Beth Israel Lahey Health declared testing guidelines to hospital members. And four Partners HealthCare hospitals started extensive testing in mid of April.

Hospitals speed up this effort after reading a letter from doctors from two hospitals in New York, issued in the New England Journal of Medicine. Among 215 women who delivered babies in late March and early April, 13.7 percent were positive but didn’t have any symptoms.

If the same held true for the Boston area, then delivery and labor staff spent plenty of uncertain time in very close reach with ladies who could be unknowingly spreading the coronavirus. The team doesn’t always wear N95 masks and protective gear during labor and delivery unless the individual is known to be positive.

“Out of an abundance of caution, we needed to be sure that we would identify these patients,” stated Dr. Ilona Goldfarb,” and also prepare the family to appropriately protect the baby and look after the infant after birth.”

Hospitals that can examine all delivery and labor patients have a tool others don’t: the ability to produce fast results.

Goldfarb, The COVID-19 head for the Massachusetts General Hospital obstetrics department, stated MGH and three other partner hospitals, Newton-Wellesley, Brigham and Women’s, and North Shore Medical Center could learn whether a patient is positive in about two hours.

At Tufts Healthcare Center, the turnaround time is presently 60-90 minutes. Only a couple of weeks back, it had been 12 hours, explained Dr. Margaret Sullivan, an OB-GYN at Tufts.

Before, it did not make clinically accepted because some mothers would give birth before the results came.

An OB-GYN at Beth Israel Deaconess Medical Center, Dr. Neel Shah, says the numbers from New York to make a compelling case for conducting a diagnostic test on all patients that are admitted for delivery. But slower test processing still remains the hold-up at a few hospitals.

“The challenge is that our testing capacity is limited and varies considerably by the hospital,” said Shah, who’s also the manager of the Delivery Decisions Initiative in Ariadne Labs. A spokesperson for the BILH network said it generally takes six to eight hours to get a coronavirus test result, even though a quick test is available when the result would change the patient’s care.

And policies vary too. Shah said, most hospitals need two tests to be sure that the patient doesn’t have COVID-19, which requires time, although some doctors run one test to determine that a patient is negative.

“With limited PPEs and restricted COVID rooms, and with the realities of labor and delivery [individuals in labor can progress and deliver quickly], definitively testing everyone isn’t always possible,” he said.

It’s too early to decide if Boston will see rates of positive, asymptomatic women delivering in the same numbers as the two New York hospitals. In one week of testing, MGH has seen three women who tested positive but didn’t show any symptoms of the coronavirus.

At MGH, Goldfarb said ladies who are sick and tested positive follow the same precautions to protect their babies as do women who didn’t have symptoms. Newborn babies are allowed in the same room as their parents but at a distance of six feet.

Goldfarb said the objective is “educating the mother and the family how to use good hand hygiene, how to put on a mask, how to take care of the infant as safely as possible knowing that mother and baby and family were going to be in the house together in short order.”

That care includes breastfeeding. Goldfarb said, until now, there are no cases where the coronavirus has been discovered in breast milk. She suggests mothers who are positive to use a mask when feeding, wear a neat gown, and take care of hygiene. MGH prepares bundles of PPE to send home with these families. Goldfarb said it is best if a healthy person handles the majority of the care of the baby until the mother is no longer infectious.

At Tufts Medical Center, if the mother tests positive for the coronavirus, infants are placed in the NICU.

Sullivan said the Tufts policy is that infants can have breast milk if the mother pumps and one other feeds the baby. Sullivan emphasizes that all of these policies are subject to change as obstetricians know about the coronavirus, and as the number of COVID patients increases.

Sullivan asked, “What might happen if mothers who are didn’t have symptoms refuse to be isolated from their new infants?  “It’s a very fluid condition,” she said. As the world learns more about this virus policies and guidelines will be updated.

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