Subscribe to RSS
Obstetrical Unit Response to the COVID-19 Pandemic: OUR StudyFunding REDCap support was provided by the Clinical and Translational Science Institute Grant (CTSI Grant UL1TR001881).
Objective This study aimed to describe the response of labor and delivery (L&D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE).
Study Design A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through “snowballing.” A single representative was asked to respond on behalf of each L&D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage.
Results A total of 301 surveys (estimated 51.5% response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31%), community teaching (45%) and nonteaching hospitals (24%). Sixteen percent of respondents were from states with high prevalence, defined as higher “deaths per million” rates compared with the national average. Universal laboratory testing for admissions was reported for 40% (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.23–2.42) and high prevalence states (aOR = 2.68, 95% CI: 1.37–5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33% and for cesarean delivery in 38% of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95% CI: 1.29–5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95% CI: 0.24–0.73).
Conclusion Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely to recommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use.
Heterogeneity is seen in institutional recommendations for viral testing and PPE.
Universal laboratory testing for COVID-19 is more common at academic centers.
N95 mask use during vaginal deliveries is less likely in places with universal testing.
KeywordsCOVID-19 - pandemic - personal protective equipment - infection prevention - labor and delivery
Received: 01 July 2020
Accepted: 29 July 2020
Article published online:
06 September 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Emergencies preparedness, response. Pneumonia of unknown cause–China. Available at: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/ . Accessed May 8, 2020
- 2 Holshue ML, DeBolt C, Lindquist S. et al; Washington State 2019-nCoV Case Investigation Team. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; 382 (10) 929-936
- 3 Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91 (01) 157-160
- 4 World Health Organization. Coronavirus disease (COVID-2019) situation reports. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports . Accessed May 25, 2020
- 5 Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. COVID19 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020; 223 (01) 36-41
- 6 Center for Disease Control and Prevention. Considerations for inpatient obstetric healthcare settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html . Accessed May 9, 2020
- 7 Center for Disease Control and Prevention. Clinical questions about COVID-19: questions and answers. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html . Accessed May 9, 2020
- 8 American College of Obstetricians and Gynecologist Practice Advisory. General information regarding pregnant individuals and COVID-19. Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019 . Accessed August 5, 2020
- 9 Society for Maternal-Fetal Medicine. Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2322/COVID19-What_MFMs_need_to_know_revision_4-11-20_(final)_highlighted_changes._PDF.pdf . Accessed August 5, 2020
- 10 Palatnik A, McIntosh JJ. Protecting labor and delivery personnel from COVID-19 during the second stage of labor. Am J Perinatol 2020; 37 (08) 854-856
- 11 Berghella V. NOW!: protection for obstetrical providers and patients. Am J Obstet Gynecol MFM 2020; 2 (02) 100109 . (e-pub ahead of print) DOI: 10.1016/j.ajogmf.2020.100109.
- 12 Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol MFM 2020; 2 (02) 100106 . (e-pub ahead of print) DOI: 10.1016/j.ajogmf.2020.100106.
- 13 Kampf G, Scheithauer S, Lemmen S, Saliou P, Suchomel M. COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves and gowns - proposal for a risk-adapted approach to ensure patient and healthcare worker safety. J Hosp Infect 2020; 105 (03) 424-427
- 14 Laboratory testing strategy recommendations for COVID-19. Available at: https://apps.who.int/iris/bitstream/handle/10665/331509/WHO-COVID-19-lab_testing-2020.1-eng.pdf . Accessed August 5, 2020
- 15 Valerio MA, Rodriguez N, Winkler P. et al. Comparing two sampling methods to engage hard-to-reach communities in research priority setting. BMC Med Res Methodol 2016; 16 (01) 146
- 16 Pluym ID, Paek B, Walker M. et al. Novel use of a social-media-based survey to detect regional differences in management of monochorionic-diamniotic twins. Am J Perinatol 2020; 37 (09) 890-897
- 17 Worldmeters.info. Available at: https://www.worldometers.info/coronavirus/country/us/ . Accessed April 21, 2020
- 18 ID NOW COVID-19. Available at: https://www.alere.com/en/home/product-details/id-now-covid-19.html . Accessed May 9 2020
- 19 O'Sullivan ED. PPE guidance for covid-19: be honest about resource shortages. BMJ 2020; 369: m1507
- 20 World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health. Available at: https://www.who.int/publications-detail/coronavirus-disease-(covid-19)-outbreak-rights-roles-and-responsibilities-of-health-workers-including-key-considerations-for-occupational-safety-and-health . Accessed May 9, 2020
- 21 Heneghan C, Oke J, Jefferson T. COVID-19 How many Healthcare workers are infected?. Available at: https://www.cebm.net/covid-19/covid-19-how-many-healthcare-workers-are-infected/ . Accessed May 9, 2020
- 22 Lai CC, Liu YH, Wang CY. et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect 2020; 53 (03) 404-412
- 23 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020; 382 (22) 2163-2164
- 24 Centers for Disease Control and Prevention. 03/21/2020: lab alert: CDC posts new standard operating procedure for creating viral transport media. center for disease control. Available at: https://www.cdc.gov/csels/dls/locs/2020/new_sop_for_creating_vtm.html . Accessed May 9, 2020
- 25 Centers for Disease Control and Prevention. Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19). Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html . Accessed May 9, 2020
- 26 A letter: PPE use for obstetrician care providers. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2280/COVID_CDC_PPE_letter.obcareproviders.pdf . Accessed August 5, 2020
- 27 Premier Inc. survey: as COVID-19 spreads to new hotspots, hospitals should prepare for up to a 17x surge in supply demand. Available at: https://www.premierinc.com/newsroom/press-releases/premier-inc-survey-as-covid-19-spreads-to-new-hotspots-hospitals-should-prepare-for-up-to-a-17x-surge-in-supply-demand . Accessed May 9, 2020
- 28 Carias C, Rainisch G, Shankar M. et al. Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clin Infect Dis 2015; 60 (Suppl. 01) S42-S51
- 29 Garcia Godoy LR, Jones AE, Anderson TN. et al. Facial protection for healthcare workers during pandemics: a scoping review. BMJ Glob Health 2020; 5 (05) e002553
- 30 National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Available at: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html . Accessed May 9, 2020
- 31 Werner EF, Louis JM, Hughes B, Han CS, Norton ME, Srinivas SK. Community obstetrical units less likely than academic units to have universal COVID-19 testing. Am J Perinatol 2020; 37 (10) 1074-1076
- 32 Saenger AK, Berkwits M, Carley S. et al. The power of social media in medicine and medical education: opportunities, risks, and rewards. Clin Chem 2018; 64 (09) 1284-1290