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Dear editor: In Mexico and the world maternal morbidity and mortality have increased drastically during the Covid-19 pandemic.1 In 2020, 21.6% of maternal deaths in Mexico were caused by Covid-19 related complications.2 A high percentage of asymptomatic SARS-CoV-2 infection has been described in pregnant patients.3 Internationally routine Covid-19 testing prior to admission to the obstetric ward and safety protocols have shown to be the most reliable method to detect and manage Covid-19 positive patients promptly.3
We conducted a cross-sectional study seeking to describe the prevalence of SARS-CoV-2 and the clinical presentation in positive pregnant patients in an academic hospital in Northeast Mexico where universal screening for SARS-CoV-2 is carried out. We reviewed the records of patients admitted to the service for obstetric management between April and July 2020 at our institution.
In total, 684 were admitted and screened through RT-PCR (TaqMan 2019-nCoV Assay Kit by ThermoFisher Scientific); 641 patients were admitted for birth care; 43 patients were admitted for other obstetric procedures, and only seven patients were admitted for Covid-19 disease management. Regarding SARS-CoV2 status, 626 (91.5%) patients were negative and 58 (8.4%) were positive. 75.9% of positive patients were asymptomatic at initial evaluation. Only one patient that was initially asymptomatic developed symptoms of mild Covid-19 disease during management. In the symptomatic group, the most common reported symptoms were fever (57%), cough (50%), dyspnea (50%), and headache (42%). Notably, only six patients required intensive care unit management. The rest of the clinical and management data are depicted in table I.
Table I Characteristics of SARS-CoV-2 carriers and non-carriers admitted to our obstetric unit
|
SARS-CoV-2 PCR negative patients (n=626) |
SARS-CoV-2 PCR positive patients (n=58) |
||
|
Symptomatic (n=14) |
Asymptomatic (n=44) |
||
|
Emergency consult |
212 |
13 |
20 |
|
Scheduled operative procedure |
414 |
1 |
24 |
|
Reason for admission |
|||
|
Coronavirus disease |
0 |
7 |
0 |
|
Obstectric cause |
626 |
7 |
44 |
|
Severity |
|||
|
Mild-Moderate |
NA |
6 |
1 |
|
Severe |
NA |
6 |
0 |
|
Critical |
NA |
2 |
0 |
|
Covid-19 management |
|||
|
Antibiotics/Antivirals |
NA |
8 |
1 |
|
Steroids |
NA |
6 |
0 |
|
Plasma |
NA |
1 |
0 |
|
Ventilatory support |
NA |
9 |
0 |
|
-O2 nasal canula |
NA |
5 |
1 |
|
-High flow nasal canula |
NA |
2 |
0 |
|
-Mechanical ventilation |
NA |
2 |
0 |
|
ICU admission |
NA |
6 |
0 |
ICU: intensive care unit
Data collected from April-July 2020; Hospital Zambrano Hellion TecSalud and Hospital San Jose TecSalud
Most of the patients in the positive group were asymptomatic upon admission and during the course of their hospital stay. These patients were identified and treated correctly due to the universal SARS-CoV-2 detection policy that exists in our institution. Asymptomatic patients and patients in the latent phase of the disease represent a safety risk both for themselves and for the health personnel providing care for them. We consider that although there may be logistic complications and a theoretical increase in the cost of care with the implementation of universal screening, this allows the early identification of cases and ensures their correct management and infection precaution implementation.
