Current evidence from a high-prevalence area suggests that many pregnant women with
novel coronavirus disease 2019 (COVID-19) are asymptomatic when they present for delivery.[1 ] Obstetric deliveries occur at both academic and community hospitals and the site
of delivery is not likely to be altered by the pandemic. If COVID-19 specific resources
differ between academic and community hospital obstetric units, this could result
in disparate disease transmission rates and care. This has the potential to place
large numbers of patients, their families, and health care workers at risk. In response
to member concerns, the Society for Maternal-Fetal Medicine (SMFM) surveyed its state
liaison representatives using a web-based survey (https://www.surveymonkey.com/r/COVIDSLNsurvey ) regarding COVID-19 testing and access to personal protective equipment (PPE) on
obstetrical units between April 7, 2020 and April 14, 2020. We sought to determine
current COVID-19 testing strategies on admission and PPE use at delivery across the
United States.
Of the 56 maternal-fetal medicine physicians who responded from 38 states and the
District of Columbia, 63% (n = 35) were from academic institutions with the remainder from community hospitals.
The 1-week response rate was 16.6% (337 members received the survey) from 78% of the
states with members. In this small but geographically diverse sample, academic institutions
and community hospitals had a similar volume of COVID-19 obstetric patients admitted
per week ([Fig. 1 ], p = 0.76). Among respondents, 20% (11/56) reported that their hospitals were performing
universal testing for women admitted for inpatient obstetrical care and 27% (15/56)
were considering but had not initiated this practice. Universal testing varied within
states and did not correlate with COVID-19 inpatient obstetrical volumes; 31% (5/16)
of hospitals that admitted three or more COVID-19 affected patients per week were
performing universal testing compared with 15% (6/40) of hospital that admitted less
than three COID-19 affected patients per week, p = 0.26. Universal testing rates differed significantly between hospitals types with
29% (10/35) of academic-affiliated respondents reporting universal testing compared
with 5% (1/21) of community hospital (p = 0.04). All respondents reported adequate access to surgical masks, 96% (54/56)
reported using N95s for deliveries of COVID-19 affected patients and 25% (14/56) reported
using N95s for all deliveries. Universal N95 masking at delivery did not differ significantly
between academic and community hospitals (29% compared with 19%, p = 0.53).
Fig. 1 COVID-19-positive obstetric patient volume by hospital affiliation. COVID-19, novel
coronavirus disease 2019.
Unlike many gynecologic visits that can be postponed or conducted virtually, obstetrical
delivery timing often cannot be adjusted. Therefore, it is critical to develop strategies
to ensure the safety of patients and health care workers in this environment. Although
practices and guideline are rapidly evolving, this recent survey suggests that academic
and community hospitals are encountering COVID-19 patients and recommending universal
N95 masking at the time of delivery at similar rates. However, universal COVID-19
testing at the time of obstetrical admission is more common at academic than community
hospitals and does not correlate with COVID-19-positive patient volume. These imbalances
in testing practices may prevent universal COVID-19 testing from achieving its intent;
identifying asymptomatic carriers across a community to mitigate disease spread. Low-prevalence
areas can very quickly become high-prevalence areas. Therefore, implementation of
universal testing should be strongly considered in all obstetric hospitals, regardless
of their academic or community affiliation as an important strategy to reduce community
spread.
