Asymptomatic Pregnant Women with Covid-19
Dear Obstetric Shared Care GPs,
As we head into the third week of April, Easter now seems far away. The COVID-19 pandemic continues to unfold so rapidly and is changing constantly. The GP Obstetric Shared Care Program continues to look to produce information and resources that can guide and assist you during this time when treating your antenatal and postnatal patients. As well as providing you with some interesting reading.
Across Australia there has been a pleasing flattening of the curve (thus far…). Given the baseline prevalence seems low at the minute – which gives us a little breathing space.
We all have been so swept up by COVID-19 these last two months and we hope it will be refreshing to revisit our core business very soon in the future.
For this update we present two papers that reported something that you might have heard about, and which may have caused you some concern – pregnant women with COVID-19 who were asymptomatic.
While it looks like it is a thing, we do not think the slightly alarming findings in New York City applies to the current situation in Australia because our baseline prevalence (as of mid April) is likely to be really low. And may it stay that way!
Secondly, we will take a brief look at this – the antiretroviral drug Remdesivir as a treatment for COVID-19.
We hope these updates are interesting to you all.
Paper 1 and 2: Asymptomatic pregnant women with COVID-19
COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Breslin et al. AMJOG MFM (09/04/20) (Full text available on link).
- Retrospective review over a 15-days in two NYC hospitals (Columbia University Irving and Allen Hospitals).
- Patients were initially screened between March 13-21 based on symptoms and risk factors for Covid-19; universal screening was then commenced from March 22nd.
- 43 patients tested positive for Covid-19 (7 identified by risk factor screening and 36 identified by universal testing).
- Covid-positive patients were young (average 27 years of age), obese (60.5% BMI>30) and more than 41% had an additional comorbidity (asthma, type 2 diabetes, chronic hypertension).
- 37/43 (86%) of women had mild disease, 4 were severe and 2 were critical (requiring ICU).
- Symptomatic disease: 29/43 (67.4%) positive patients had symptoms consistent with Covid-19 infection – dry cough (65.9%), fever (48.3%), shortness of breath (24.1%) and chest pain (17.2%)
- Asymptomatic disease: 14/43 who were positive were asymptomatic at the time they were screened – of these, only 2/14 developed symptoms during obstetric/labour admission (both required ICU admission).
- At the time of the report 18 women had birthed. 8/18 (44.4%) had a caesarean section and 10/18 (55.5%) had a vaginal birth. ALL 18 had epidural and/or spinal.
- There was no evidence of vertical transmission. Reassuringly, none of the 18 infants tested positive for Covid-19 within the first six days.
- It is unclear how many total patients were delivered during this time to calculate the % who were Covid-19 positive.
- The authors conclude that universal testing should be considered for obstetric patients due to high rates of asymptomatic infection.
We strongly stress that these findings are unlikely to be generalisable to the current Australian situation as our overall prevalence at the moment (touch wood) seems to be very low. We suggest the data indicates that universal screening might be considered in settings where the baseline prevalence is high.
Paper 3: What treatments are being trialed?
With the global COVID-19 death toll approaching 150,000, researchers are accelerating clinical trials at a rate never before seen, with close to 600 newly registered COVID-19 trials.
Therapies that are being evaluated (but are not yet proven) include hydroxychloroquine which we highlighted previously (now 90 registered trials), those aimed at reducing the ‘cytokine storm’ such as anti-TNF and anti-IL-6 therapy (collectively >40 registered trials), and those utilising antiviral therapies, including Remdesivir.
Remdesivir is a viral RNA polymerase inhibitor shown to have activity against SARS-CoV-2 in-vitro. Following pre-clinical success and a small case series, 5 additional trials are now underway, with the two largest trials aiming to recruit 3,100 patients in France and 2,400 patients across 155 sites worldwide. The anticipated end of recruitment is May 2020.
MORE RESOURCES FOR YOU
- GP Maternity Care for Rural and Remote women
Recorded webinar hosted by Rural Doctors Association Queensland.
- Maternity Care during COVID-19 for low-risk women
- Worried about children and coronavirus? Here are some strategies. (newsGP article)
- Maternity Matters
Please note that the information supplied here are not official clinical guidelines and are not RACGP endorsed but have been produced to offer you practical assistance.
GP Obstetric Shared Care VIRTUAL ONLINE CONFERENCE
We will be announcing our upcoming virtual CPD Activity – A great theme which will explore how COVID-19 is changing Obstetric practice now and discuss as how the Program will look when we come out the other side of this pandemic. Plus more, much more!
We will have a great program with exciting guest speakers.
Please feel free to share this with your clinical colleagues and Practice Nurses/Midwives who may be interested.
Don’t forget to visit our GP Partners Australia website for further updates and resources www.gppaustralia.org.au
We trust this – and future updates – will be of help to you during these unsettling times.
If you have any questions or require additional information please do not hesitate to contact the GP Obstetric Shared Care Program Manager – Leanne at firstname.lastname@example.org