may 2020 • American Journal of Obstetrics and Gynecology

SARS-CoV-2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg

Khalil A, Hill R, Ladhani S, Pattisson K, O’Brien P

DOI: 10.1016/j.ajog.2020.05.005

Content curated by:Joana Vaz

Key message

Apesar da prevalência no estudo Londrino ser metade da reportada no de NY (7% vs 15%, talvez por haver menor transmissão na comunidade e maior variedade de étnicas de mulheres que se apresentaram em hospitais em NY) a proporção de assintomáticas foi similar (Londres 88.9% vs NY 87.9%). Já o estudo Italiano sugere prevalência muito menor (0.56%) mas percentagens de assintomáticas similar aos estudos anteriores (cerca de 75%). Mulheres grávidas que se apresentam num hospital para o parto são uma fonte de informação única, uma vez que se apresentam independentemente do factor doença (na maioria dos casos). O screening universal nesta população é encorajado, podendo continuar a ajudar nas estimativas para a população geral, podendo também ajudar no controlo de infecção, gestão do uso de EPI e transmissão nosocomial.

Abstract

Objectives: Pregnant women present a unique challenge during this COVID-19 pandemic as they have multiple encounters with healthcare workers (HCW) and most are admitted to hospital for birth. Universal screening of this population, therefore, has several potential benefits: reducing the risk of asymptomatic transmission to HCW and other pregnant women; early patient isolation and use of appropriate personal protective equipment; and improving understanding of perinatal transmission. The prevalence of SARS-CoV-2 in pregnant women admitted for delivery in one New York hospital between March 22 and April 4, 2020 was 33/215 (15.4%) and 29/33 (88%) were asymptomatic. Such a high proportion of asymptomatic infection was unexpected and raises questions about infection control practices in hospitals that do not routinely screen for SARS-CoV-2 in women presenting for birth. It is also not known whether this rate is generalizable to other pregnant populations.