Universal screening for SARS-CoV-2 infection among pregnant women at Elmhurst Hospital Center, Queens, New York

  1. Sheela Maru
  2. Uday Patil
  3. Rachel Carroll-Bennett
  4. Aaron Baum
  5. Tracy Bohn-Hemmerdinger
  6. Andrew Ditchik
  7. Michael L. Scanlon
  8. Parvathy Krishnan
  9. Kelly Bogaert
  10. Carson Woodbury
  11. Duncan Maru
  12. Lawrence Noble
  13. Randi Wasserman
  14. Barry Brown
  15. Rachel Vreeman
  16. Joseph Masci

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic.

Methods and findings

We conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women.

A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative.

Conclusions

In this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.

Article activity feed

  1. Version published to 10.1371/journal.pone.0238409
  2. ScreenIT

    SciScore for 10.1101/2020.08.12.20171694: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical approval: This study was approved by the Institutional Review Board at the Icahn School of Medicine at Mount Sinai, IRB-20-03424, and approved by NYC Health + Hospitals.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableStudy design and setting: We retrospectively reviewed medical charts of all pregnant women who were universally screened for SARS-CoV-2 on admission to the L&D Unit at Elmhurst Hospital.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of our study was the use of two different test types for universal screening. We were initially using BioReference Laboratory tests which returned in several days, and as rapid tests became available we switched to the Cepheid Rapid PCR. These tests likely had different sensitivities and specificities (though we were not provided with this information) and may have affected our screening results. SARS-CoV-2 screening fundamentally shifted the way we roomed, counseled, and followed women (Fig 2). Cohorting women by SARS-CoV-2 infection status allowed us to most safely use the restricted space. Several walls were built to further partition the space in the triage, labor, and postpartum areas in order to ensure separation of SARS-CoV-2 positive women and those of unknown status from women known to be negative. In the early days of the pandemic, SARS-CoV-2 positive mothers were roomed separately from their infants, however, this procedure was reconsidered as the volume of known SARS-CoV-2 positive mothers increased with universal screening. Given limited physical space and staff to isolate all infants and considering the importance of simulating the home-environment during the postpartum hospitalization to promote safe infant care and breastfeeding, we proceeded with shared decision making with SARS-CoV-2 positive mothers around rooming-in with their infants. Severe overcrowding of housing is a challenge where most of our mothers live, making isolation of a baby an...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.12.20171694v1 on medRxiv