Utility of lung ultrasound assessment for probable SARS‐CoV‐2 infection during pregnancy and universal screening of asymptomatic individuals

Abstract

Letters to the Editor Utility of lung ultrasound assessment for probable SARS-CoV-2 infection during pregnancy and universal screening of asymptomatic individuals Pregnant women are a risk group for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which has been shown to be associated with increased rates of preterm delivery and Cesarean section 1. Despite reassuring safety profile, imaging modalities, such as computed tomography, are used scarcely in pregnancies with suspected SARS-CoV-2 infection due to concerns about undue exposure of the fetus to ionizing radiation. However, false-positive and false-negative results are not uncommon in reverse transcription polymerase chain reaction (RT-PCR) testing. Anecdotal reports suggest that the adjunct use of imaging modalities can help manage cases in which molecular testing results and the clinical presentation are conflicting 2. Furthermore, use of imaging modalities is suggested for the preoperative screening of emergency cases 3. Lung ultrasound (LUS) is an ionizing-radiation-free, reproducible imaging modality for evaluating lung lesions, and its results are readily available, well in advance of the RT-PCR results 4. However, the added benefit of LUS for managing symptomatic and asymptomatic patients with SARS-CoV-2 infection during pregnancy remains unclear. This was a retrospective cohort study conducted in two large SARS-CoV-2 pandemic hospitals in Turkey (

Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19

“…In comparison to standard dose CT, LUS showed a sensitivity of 66.67% and a positive predictive value of 100% [56]. In a study including pregnant women, the utility of LUS added to the exposure history for predicting a positive COVID-19 RT-PCR was demonstrated for symptomatic women, but not for asymptomatic ones [57].…”

Echocardiography, Lung Ultrasound and Cardiac Magnetic Resonance Findings in COVID-19: A Systematic Review

“…Given obstetricians/gynecologists use ultrasound in their routine examinations, the systematic utilization of this practice to expand to LUS evaluation has previously been proposed [98]. Usefulness of LUS in assessing lung involvement in pregnant women with suspected or confirmed COVID-19 infection has been explored in several studies [99][100][101]. The addition of LUS scoring to symptoms and exposure history in pregnant women had significant impact on the prediction of a positive RT-PCR result, increasing the positive predictive value of the model from 77.1% (95% CI, 67.0-84.8%) to 93.7% (95% CI, 83.7-97.8%) [100].…”

“…Usefulness of LUS in assessing lung involvement in pregnant women with suspected or confirmed COVID-19 infection has been explored in several studies [99][100][101]. The addition of LUS scoring to symptoms and exposure history in pregnant women had significant impact on the prediction of a positive RT-PCR result, increasing the positive predictive value of the model from 77.1% (95% CI, 67.0-84.8%) to 93.7% (95% CI, 83.7-97.8%) [100]. In a series of 8 pregnant women with a positive COVID-19 RT-PCR, who underwent point-of-care LUS examinations after routine obstetric ultrasound, Yassa M et al was able to detect serious lung involvement in 7 patients, significantly influencing their management and providing an alternative imaging modality in 2 patients not willing to undergo a CT chest [101].…”

Scientific effort in combating COVID‐19 in obstetrics and gynecology

“…In early September, Kalafat et al 48 . showed that the use of lung ultrasound scoring could facilitate the early diagnosis of symptomatic women with probable SARS‐CoV‐2 infection and could be useful for managing patients when testing capacity is strained or when waiting for testing results is not an option.…”