OBJECTIVE: This study was aimed to review 4 weeks of universal novel coronavirus disease 2019 (COVID-19) screening among delivery hospitalizations, at two hospitals in March and April 2020 in New York City, to compare outcomes between patients based on COVID-19 status and to determine whether demographic risk factors and symptoms predicted screening positive for COVID-19 . STUDY
DESIGN: This retrospective cohort study evaluated all patients admitted for delivery from March 22 to April 18 , 2020, at two New York City hospitals . Obstetrical and neonatal outcomes were collected . The relationship between COVID-19 and demographic, clinical, and maternal and neonatal outcome data was evaluated . Demographic data included the number of COVID-19 cases ascertained by ZIP code of residence . Adjusted logistic regression models were performed to determine predictability of demographic risk factors for COVID-19 .
RESULTS: Of 454 women delivered , 79 (17 %) had COVID-19 . Of those , 27.9% (n = 22) had symptoms such as cough (13.9 %), fever (10.1 %), chest pain (5.1 %), and myalgia (5.1 %). While women with COVID-19 were more likely to live in the ZIP codes quartile with the most cases (47 vs. 41 %) and less likely to live in the ZIP code quartile with the fewest cases (6 vs. 14 %), these comparisons were not statistically significant (p = 0.18). Women with COVID-19 were less likely to have a vaginal delivery (55.2 vs. 51.9%, p = 0.04) and had a significantly longer postpartum length of stay with cesarean (2.00 vs. 2.67days, p <0.01). COVID-19 was associated with higher risk for diagnoses of chorioamnionitis and pneumonia and fevers without a focal diagnosis . In adjusted analyses, including demographic factors, logistic regression demonstrated a c-statistic of 0.71 (95% confidence interval [CI]: 0.69 , 0.80).
CONCLUSION: COVID-19 symptoms were present in a minority of COVID-19-positive women admitted for delivery . Significant differences in obstetrical outcomes were found . While demographic risk factors demonstrated acceptable discrimination, risk prediction does not capture a significant portion of COVID-19-positive patients .
KEY POINTS: · COVID-19 symptoms were present in a minority of COVID-19-positive women admitted .. · COVID-19 symptomatology did not appear to differ before or after the apex of infection in New York .. · Demographic risk factors are unlikely to capture a significant portion of COVID-19-positive patients ..