Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
-
Guy Haller
,
Frédérique Jacquerioz Bausch
To the Editor,
We welcome the results of Dr R. Figueiredo et al. study on the use of a universal screening strategy for SARS-CoV-2 in the University Hospital of Porto [1]. Following the systematic screening of 184 patients, they identified 11 women testing positive for SARS-CoV-2. Of these only two were symptomatic at initial testing. As a result, they recommend universal laboratory testing by standard polymerase chain reaction (PCR) tests to guide personal protections use and patient orientation within the hospital. We would however like to emphasize the challenges of such a strategy should it be universally generalized. One is, despite major efforts, limited worldwide availability of reliable testing kits and accredited laboratories. This may preclude in a number of countries the performance of standard polymerase chain reaction (PCR) tests at a large scale [2], [3]. Another, is the accuracy of the test itself. It depends both on its core characteristics (sensitivity/specificity) and the prevalence of the infection. The SARS-CoV-2 PCR test, because it relies on the ability to capture the virus present in sputum or nasopharyngeal swab has a sensitivity of approximately 63% (32–72) and an assumed specificity of 99% [4]. Depending on the prevalence of the disease, its performance will vary significantly (Figure 1). For instance, using the annual Portuguese birth rate figure of 79 494 [5], if a universal testing strategy is used in areas with low prevalence of infection (i.e. Porto, 5.97%) this result in 11.1% of perfectly healthy women having a positive SARS-CoV-2 test. In contrast, should the infection prevalence reach 38% [6], such as in China, 18.6% of infected women would have a negative SARS-CoV-2 test (Figure 1). If we fully support universal screening strategies, we would like to highlight its pitfalls and remind that it cannot be used as an exclusive guide of hospital isolation practices and personal protection equipment use.
Proportion of testing errors.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
References
1. Figueiredo, R, Tavares, S, Moucho, M, Ramalho, C. Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery in a Portuguese maternity. J Perinat Med 2020;48:977–80. https://doi.org/10.1515/jpm-2020-0387.Suche in Google Scholar PubMed
2. Services of the US Department of Health, Office of Inspector General. Hospital experiences responding to the COVID-19 pandemic: results of a National Pulse Survey; 2020. Available from: https://www.oversight.gov/report/hhsoig/hospital-experiences-responding-covid-19-pandemic-results-national-pulse-survey-march [Accessed Nov 2020].Suche in Google Scholar
3. Tanne, JH, Hayasaki, E, Zastrow, M, Pulla, P, Smith, P, Rada, AG. Covid-19: how doctors and healthcare systems are tackling coronavirus worldwide. BMJ 2020;368:m1090. https://doi.org/10.1136/bmj.m1090.Suche in Google Scholar PubMed
4. Wang, W, Xu, Y, Gao, R, Lu, R, Han, K, Wu, G, et al.. Detection of SARS-CoV-2 in different types of clinical specimens. J Am Med Assoc 2020;323:1843–4. https://doi.org/10.1001/jama.2020.3786.Suche in Google Scholar PubMed PubMed Central
5. World population demographics and statistics. Available from: https://countrymeters.info/en/Portugal [Accessed Nov 2020].Suche in Google Scholar
6. Kim, H, Hong, H, Yoon, SH. Diagnostic performance of CT and reverse transcriptase-polymerase chain reaction for coronavirus disease 2019: a meta-analysis. Radiology 2020;296:145–55.10.1148/radiol.2020201343Suche in Google Scholar PubMed PubMed Central
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
Artikel in diesem Heft
- Frontmatter
- In Memorian
- Robert L. Brent, MD, PhD (1927–2021)
- Review
- Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
- Original Articles – Obstetrics
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
- Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
- Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
- Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
- Doppler ultrasonography of the uterine artery in correlation with KANET
- The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
- The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
- Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
- Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
- Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
- Original Articles – Fetus
- Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
- Original Articles – Neonates
- Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
- Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
- Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
- Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
- Letter to the Editor
- Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
