A lot of us caring for pregnant women in the US have been eagerly awaiting data from US-based facilities as they predominantly reflect our patient population, and routine practice patterns. Fortunately, the folks at New York Presbyterian Hospital and Columbia University Medical Center just published their experience with 43 pregnant women, which is an amazing accomplishment considering they’re dealing with the COVID-19 surge as we speak. With that said, here is the summary of their findings in the American Journal of Obstetrics and Gynecology.
Study period: 2 weeks (starting 3/13/2020 to 3/27/20)
Study population: 43 pregnant women presenting to Labor and Delivery units at the study hospitals that were confirmed to be COVID-19 positive
Results of the asymptomatic group: Of the 43 women in the report, 1/3 (14 women) were asymptomatic on presentation. Four of these women (33%) remained asymptomatic through delivery and recovery. The remaining women went on to experience fever, but none of them developed respiratory symptoms while in the hospital. Out of this group of women, 46% went on to develop the classic COVID-19 symptoms at home within 7 days of the positive test results, and these symptoms included cough, fatigue, myalgia, and chest pain. None of them required readmission to the hospital.
Results of the symptomatic group: Of the 43 women in the report, 2/3 (29 women) had COVID-19 related symptoms with dry cough in 19, fever in 14, headache in 8, shortness of breath in 7, and chest pain in 5 women. Interestingly a 1/3 of these women reported a sick contact at home. Twenty-five (86%) of the women in this group were able to be discharged to home without any of them needing to be readmitted for COVID-9 related complications though 4 did come back for pregnancy related reasons including labor, broken bag of water, or induction. Four of these women did progress to needing admission to the hospital within a week of the positive test result. One received hydroxychloroquine and antibiotics to help with her pneumonia. Two of the women received hydration (along with antibiotics for one of them). One of the 4 women did have respiratory complications that required closer observation by the medicine team, but is stable and without any further complication. This woman received hydroxychloroquine, which is being provided on a case-by-case basis assessment by the infectious disease specialists as it is not an FDA approved therapy for COVID-19.
Results of their pregnancy outcomes: Of the 43 women in the report 18 went on to deliver. Of these 18 women, 56% had vaginal deliveries, and 44% had cesarean deliveries. All 18 were able to get an epidural or spinal anesthesia. None of the babies had evidence of COVID-19 infection from swabs of nose/throat.
Conclusion: The authors concluded that 1) outcomes in pregnancies complicated by COVID-19 are overall very favorable, 2) because many women do not exhibit symptoms (asymptomatic) there should be universal screening for pregnant women being evaluated on Labor and Delivery, and 3) 86% of women will have mild symptoms, 9% severe symptoms, and 5% critical symptoms which is similar to published reports in non-pregnant individuals.
The authors have to be commended for their ability to put this report out while battling the COVID-19 surge in New York City. Wishing all of you good health!