Implementation of universal testing for severe acute respiratory syndrome coronavirus 2 in pregnant women with intended admission for delivery.

To the Editors:

The Cleveland Clinic Foundation recently implemented a policy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing for all pregnant patients with planned delivery or admitted for labor at obstetrical units in Ohio. We present our experience with the feasibility of testing, issues of patient autonomy, and prevalence rates. In contrast to a recent report on universal screening of pregnant women residing in an area with a high prevalence of disease, our experience is derived from a population experiencing a low prevalence of active disease.

Patients with planned delivery were tested 3 to 5 days before admission using a Centers for Disease Control–approved real-time polymerase chain reaction testing platform. Preadmission testing was available at 2 sites. Patients presenting in spontaneous labor were tested using a rapid platform (Xpert Xpress SARS-CoV-2; Cepheid, Sunnyvale, CA). Testing was “opt-in.” Patients who declined preadmission testing were offered a rapid test at the time of admission.

From May 1, 2020, to May 15, 2020, 518 women were admitted for delivery. All 518 women had orders for testing placed. Overall, 492 results were obtained within the time frame intended for clinically relevant decision making (164 for preadmission testing and 328 for rapid testing). Twenty-six patients did not have results available within a clinically relevant time frame (12 opted out, 7 presented in rapid labor with delivery <2 hours after admission, and 7 had undetermined reasons). There were 10 patients (2%) with positive results, only 3 of whom were symptomatic. Of the 10 positive cases identified in this testing protocol, only 2 had significant medical comorbidities (both with a body mass index of >30 kg/m2). None of the 7 asymptomatic patients developed any coronavirus disease 2019 (COVID-19)–related symptoms or obstetrical complications during the delivery hospitalization. Furthermore, none of the 3 symptomatic patients required medical treatment beyond standard obstetrical therapies during the delivery hospitalization. Our finding that most COVID-19–positive patients were asymptomatic is similar to the findings of Khalil et al. In addition, our finding that COVID-19–positive patients generally experience uncomplicated delivery and postpartum courses is similar to the findings reported for a cohort from New York City. As experience accumulates, perinatal risks of infection from asymptomatic patients will become clearer.

Our experience indicates that a policy of universal testing for SARS-CoV-2 before delivery is feasible, well accepted by patients, and can be performed in a clinically relevant time frame to assist in appropriate use of personal protective equipment and assignment of hospital resources. Of the 10 cases, the finding of positive test results in 7 asymptomatic patients (70%) suggests the need for such a protocol, even in areas experiencing a low prevalence of disease.