Soffer M D, Shook L L, James K, Sawyer M R, Ciaranello A, Mahrouk R, Bernstein S N, Boatin A A, Edlow A G, York-Best C, Kaimal A J, Goldfarb I T
Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2020 Oct 27;7(11):ofaa524. doi: 10.1093/ofid/ofaa524. eCollection 2020 Nov.
Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on pregnant women hospitalized due to moderate to severe coronavirus disease 2019 (COVID-19) or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV-2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described.
We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting. We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large, academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data were collected via chart abstraction.
Of 180 pregnant patients presenting with symptoms and undergoing reverse-transcription polymerase chain reaction (RT-PCR) testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required intensive care unit care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance, and duration of symptoms did not vary significantly by trimester of infection.
Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的报告主要集中在因中度至重度2019冠状病毒病（COVID-19）住院的孕妇或在产科入院时通过普遍筛查确诊的无症状女性。许多有症状的SARS-CoV-2感染孕妇可能不符合住院标准；然而，这些女性在门诊环境中能否以及如何安全管理尚未得到充分描述。
我们试图描述症状和病毒清除时间，并确定住院的预测因素，以更好地了解在门诊环境中监测有症状COVID-19孕妇的安全性。我们在一家大型学术医疗中心对有症状、确诊COVID-19疾病的孕妇进行了一项回顾性队列研究。患者由临床医生团队进行系统的远程医疗随访，以评估症状、提供虚拟产前护理，并在适当的时候安排在专门的门诊中心进行面对面就诊。数据通过病历摘要收集。
在180名出现症状并接受逆转录聚合酶链反应（RT-PCR）检测的孕妇中，在研究期间确定了67名确诊COVID-19感染的患者。19名（28%）因COVID-19症状恶化需要急性护理，其中95%因症状严重程度通过远程医疗评估而被送往该急性护理机构。9名女性（13%）因症状恶化入院，3名需要重症监护病房护理，2名需要通气支持，2名需要分娩。出现发热、咳嗽、呼吸急促、胸痛或恶心呕吐症状的女性更有可能需要入院。从首次阳性检测到RT-PCR病毒清除的中位持续时间为26天。疾病进展、病毒清除时间和症状持续时间在感染的不同孕期之间没有显著差异。
大多数有症状COVID-19疾病的孕妇可以在门诊环境中通过对症状进展进行强化和方案驱动的监测来完成管理。
