Maternal and Perinatal Outcomes in Patients with Suspected COVID-19 and Their Relationship with a Negative RT-PCR Result

Abstract

This study was designed to examine maternal-perinatal outcomes in pregnant women with suspected coronavirus disease 2019 (COVID-19) according to the result of a real-time reverse transcription polymerase chain reaction (RT-PCR) test and to investigate possible variables that could be useful for predicting a negative RT-PCR result. Participants of this retrospective cohort study were obstetrics patients with suspected COVID-19 who underwent an RT-PCR test in a tertiary hospital in Madrid, Spain. Maternal-perinatal features were analysed according to the results of this test. Clinical, radiological and analytical characteristics that could be associated with a negative result were also explored. In a final subgroup analysis, patients were included if they had pneumonia and a negative test result for the virus. Out of the 111 obstetric patients with suspected COVID-19 that were enrolled, 38.7% returned a negative result. In this RT-PCR-negative group, we recorded lower rates of pneumonia (21.4% vs. 45.6%, p = 0.009), severe or critical clinical features (4.7% vs. 11.8% and 0.0% vs. 5.9%, p = 0.02, respectively), lower lactate dehydrogenase (LDH) levels (168 UI/L vs. 224.5 UI/L, p = 0.003), a greater need for maternal treatment (60.3% vs 24.4%, p < 0.001), a reduced need for oxygen therapy (2.4% vs 28.8%, p < 0.001) and a lower rate of intensive care unit admission (0.0% vs. 3.7%, p = 0.046) than the RT-PCR-positive group. While no differences were found in other variables, the monocyte count was higher (946.2/μL vs. 518.8/μL, p = 0.022) in this group. The predictive model for a negative test result included the monocyte count, LDH level and no need for oxygen therapy. This model was able to identify 73.5% of patients with a negative RT-PCR result. Only 11% of the patients with pneumonia testing negative for the virus had IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The proportion of pregnant women with suspected COVID-19 and a negative RT-PCR result was nearly 39%. In these patients, the symptoms were mild and the systemic severity of the disease was lower. The monocyte count, LDH level and no need for oxygen therapy were the factors that were more related to a negative test result in this group. These variables could be used to guide the management of patients with suspected COVID-19, mainly while waiting for RT-PCR results or in settings where this test is not available.

The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

“…Similarly, described overall [21.6%] and individual prematurity were strongly superior to the work published by Chawanpaiboon S. et al reporting a 10.6% worldwide, oscillating among 7.0% in Spain at 2014, 6.3% in the UK, 9.9% in the USA, or 13.4% in Northern Africa [ 71 ]. The increase in the maternal and perinatal morbidity could be related to the quick respiratory worsening of the mother, which forces an urgent and/or a planned delivery during the first wave of the pandemic [ 72 ], which was significative. The acquired knowledge about the pathophysiology and management of SARS-CoV-2 infection and the higher number of diagnoses in asymptomatic patients will probably result in a decrease in the percentage of C-sections and prematurity in future works.…”

A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

“…A similar program based on an email list was also performed in the United States [ 22 , 23 ] with a mixed telephone and video system. In both cases this was not the first telemedicine program in obstetric care; therefore, the rate of no-visits was relevant.…”

An Updated Review of SARS-CoV-2 Vaccines and the Importance of Effective Vaccination Programs in Pandemic Times

“…Every person is susceptible to SARS-CoV-2 infection, but certain groups are more likely to suffer from severe presentations of the disease. These groups include older people [ 22 ], patients with comorbidities and non-communicable diseases [ 23 , 24 ], and also pregnant women [ 25 , 26 ]. They all share an altered immune status, which is key to fully understanding SARS-CoV-2’s pathogenesis.…”