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Try out PMC Labs and tell us what you think. Learn More. Novel coronavirus disease is rapidly spreading throughout the New York metropolitan area since its first reported case on March 1, The state is now the epicenter of coronavirus disease outbreak in the United States, with 84, cases reported as of April 2, We ly presented an early case series with 7 coronavirus disease —positive pregnant patients, 2 of whom were diagnosed with coronavirus disease after an initial asymptomatic presentation.
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We now describe a series of 43 test-positive cases of coronavirus disease presenting to an affiliated pair of New York City hospitals for more than 2 weeks, from March 13,to March 27, A total of 14 patients Among them, 10 patients Of the other 29 patients There were no confirmed cases of coronavirus disease detected in neonates upon initial testing on the first day of life.
In Decembera novel coronavirus was first reported in Wuhan, Hubei province, China. Currently, the United States has the highest of test-positive cases of COVID worldwide, with estimates oftest-positive cases and deaths as of this writing.
Although data on COVID continues to inform our understanding of this disease, pregnancy-specific information remains limited. Here, we present our experience with test-positive COVID cases during pregnancy presenting to an affiliated pair of New York City hospitals for more than 2 weeks between March 13,and March 27, A retrospective review of medical records was performed over a day period starting with the first polymerase chain reaction PCR —confirmed COVID case of a pregnant patient at our institution pregnant dating Nyc NY March 13, The Columbia University Irving Medical Center is a tertiary care referral center with approximately deliveries per year, and the Allen Hospital is a closely affiliated community hospital with approximately deliveries per year.
Women were discharged home with outpatient follow-up if they had stable vital s, did not have oxygen requirement, denied ificant shortness of breath or respiratory symptoms, and were deemed suitable for telehealth follow-up. After several healthcare workers were exposed with inadequate personal protective equipment PPE using this initial approach, 5 we initiated universal COVID testing for all patients admitted to the labor unit as of March 22,in addition to symptomatic triage presentations, regardless of whether they exhibited viral symptoms or other at-risk history.
This study was reviewed and approved by the institutional review board under a waiver of informed consent. Demographic variables that were continuous and normally distributed were expressed as means and standard deviations. Nonparametric continuous variables were expressed as medians with interquartile ranges IQRs. All data were tested for normality with the appropriate result, presented as median vs mean. Categorical variables were expressed as s and percentages. In reporting outcomes, women are divided into 2 groups: 1 those who were symptomatic and 2 those who were asymptomatic and detected by screening.
The demographics of the cohort are presented in the Table.
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Maternal age ranged from 20 to 39 years with a mean age SD of The mean BMI of the cohort was Eighteen women Breslin et al. COVID among asymptomatic and symptomatic pregnant women. Of the 43 women in this cohort, 3 7. One ly symptomatic patient was notably readmitted at day 6 postpartum owing to worsening respiratory symptoms. COVID in asymptomatic and symptomatic pregnant women. Over the 2-week study period, 29 of the 43 women Of 29 women, 26 A total of 10 women Vital parameters and symptom-related return precautions were reviewed before discharge. These 25 women were followed up for 14 days via telehealth with daily telephone calls for monitoring of symptoms and maternal well-being.
However, 4 symptomatic patients Of 29 symptomatic patients with COVID who were initially cared for in the outpatient setting, 4 Three of these women were admitted to the obstetric inpatient antepartum service, whereas the fourth woman was admitted to the medicine service 6 days postpartum.
None of the antepartum women required oxygen supplementation upon admission. In consultation with infectious disease specialists, the first pregnant patient received hydroxychloroquine mg orally every 12 hours for 1 day, followed by mg daily for 4 days along with ceftriaxone 1 g intravenously every 24 hours for 2 days as treatment for possible superimposed bacterial pneumonia. This patient had continuous fever before admission, with an admission temperature of The second pregnant patient received supportive therapy with intravenous hydration only.
This patient had a coinfection with parainfluenza virus and appeared unwell upon presentation but rapidly improved with intravenous hydration. The third pregnant patient received ceftriaxone 1 g intravenously every 24 hours for 2 daysazithromycin mg orally daily for 3 daysand intravenous hydration.
Despite these women having similar objective findings, they received different treatments after consultation with the infectious disease specialists, likely owing to nuances in their clinical characteristics and evolving recommendations. The fourth patient required readmission 6 days postpartum and 7 days after COVID test confirmation.
She was initially placed on a nonrebreather face mask and eventually weaned to oxygen support via nasal cannula.
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The chest x-ray examination confirmed a bilateral multifocal pneumonia. She was admitted to the medicine stepdown unit after assessment by an intensive care unit ICU triage team. She was treated with oral hydroxychloroquine, with dosing as described ly. She currently remains an inpatient. Two of these women initially presented for obstetrically indicated labor induction. Both developed symptoms that mimicked obstetric complications, but they were ultimately diagnosed with COVID as part of a broad differential, as ly described by this group.
One of the 2 patients who required ICU readmission developed renal insufficiency and remains an inpatient receiving supportive care without current need for mechanical ventilation or dialysis. The other patient improved and was discharged home. The remaining 12 of 14 patients were asymptomatic upon presentation and identified as a result of universal testing at labor unit admission for obstetric indications.
Fever ranging from The 5 patients who developed intrapartum fever received antibiotics ampicillin and gentamicin for suspected intraamniotic infection. Three of the patients with intrapartum fever received misoprostol as part of their labor induction, 2 of whom remained on antibiotics postoperatively for treatment of pd endometritis.
Of the 3 women in whom fever developed postpartum, none had focal findings on examination or clear etiologies for their temperature pregnant dating Nyc NY. Of the 8 women who were febrile after asymptomatic diagnosis of COVID, none developed respiratory symptoms throughout their delivery hospitalization. No patients had prolonged hospitalizations, with all women discharged home on either postpartum day 2 or 3.
All 13 discharged women are being followed up per our outpatient COVID protocol by either daily telehealth or telephone calls. Of those who have been discharged home, 6 of 13 However, none of these women have required a postpartum visit to the office or emergency room.
The other 7 remain asymptomatic to date April 2, The 18 women who delivered included 4 symptomatic women upon initial presentation and 14 initially asymptomatic, as described ly. Of these, 8 women The remaining 10 women All 18 women received neuraxial anesthesia either using intrapartum epidural analgesia or spinal or combined spinal-epidural anesthesia. None had contraindications such as thrombocytopenia or sepsis to neuraxial procedure, and no hemodynamic instability and neurologic complications were noted in any of the cases.
One patient required intraoperative conversion to general anesthesia because of intraoperative hemorrhage. All 18 infants, including 3 initially admitted to the NICU, have since been discharged home. Healthy newborns were either roomed in with their mothers in isolettes whenever possible or cared for in an isolated nursery for babies of COVID—positive mothers throughout their stay.
Mothers were asked to perform hand hygiene and wear a surgical mask at all times. Mothers rooming in with babies were instructed to keep a 6-foot distance from their babies when possible.
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However, breastfeeding was encouraged with hand hygiene and maternal masking. We found that pregnant women with COVID presenting with obstetric complaints or for delivery are often asymptomatic, suggesting a protocol of universal testing for pregnant women admitted to the labor unit.
Our findings are similar to the published case series from China of pregnant women with COVID that showed overall favorable prognosis. However, these case series are small. None of these patients required ICU admission or mechanical ventilation.
None of these women had preexisting comorbidities, and none required intensive care or intubation. Two of these women were asymptomatic at presentation and underwent testing owing to epidemiologic contact history. However, on computed tomography evaluation, lesions consistent with COVID pneumonia were detected. In contrast to these series, 4 patients in this case series had severe disease and another 2 women developed critical presentations that required intensive care. Although the overall is small, based on this limited case series, the course of COVID during pregnancy appears roughly comparable with what was described outside of pregnancy.
However, there are reasons why conclusions such as this may be false and misleading.
Nonpregnant patients presenting to care during the COVID outbreak generally present owing to worsening respiratory symptoms, whereas many pregnant women in this case series presented to care for ongoing obstetric reasons and before the onset of upper respiratory tract viral infection symptoms or fever. Our policy of universal testing for women admitted for delivery revealed an unexpected of asymptomatic cases and suggested a milder course of disease in general. A universal testing strategy may therefore identify a milder subset of asymptomatic or presymptomatic women who are currently underrepresented in general population testing data, which is plagued by testing shortages and test rationing.
As a result, there is likely an overrepresentation of sicker patients with COVID in this broad test-positive cohort. Moreover, the only ICU admissions in this series were of asymptomatic women; hence our findings must be interpreted with caution until more data become available.