Questionnaire‐based vs universal PCR testing for SARS‐CoV‐2 in women admitted for delivery

Mei‐Dan, Elad; Satkunaratnam, Abheha; Cahan, Tal; Leung, Marian; Katz, Kevin; Aviram, Amir

BACKGROUND: It has been suggested that women admitted for delivery should have universal PCR testing for SARS‐CoV‐2. Yet, the considerable difference in the incidence of COVID‐19 between different geographic regions may affect screening strategies. Therefore, we aimed to compare questionnaire‐based testing versus universal PCR testing for SARS‐CoV‐2 in women admitted for delivery. METHODS: A prospective cohort study of women admitted for delivery at a single center during a four‐week period (April 22‐May 25, 2020). All women completed a questionnaire about COVID‐19 signs, symptoms, or risk factors, and a nasopharyngeal swab for PCR for SARS‐CoV‐2. Women who were flagged as suspected COVID‐19 by the questionnaire (questionnaire‐positive) were compared with women who were not flagged by the questionnaire (questionnaire‐negative). RESULTS: Overall, 446 women were eligible for analysis, of which 54 (12.1%) were questionnaire‐positive. PCR swab detected SARS‐CoV‐2 in four (0.9%) women: 3 of 392 (0.8%) in the questionnaire‐negative group, and 1 of 54 (1.9%) in the questionnaire‐positive group (P = .43), yielding a number needed to screen of 92 (95% CI 62‐177). In 96% of the cases, the PCR results were obtained only in the postpartum period. No positive PCR results were obtained from neonatal testing for SARS‐CoV‐2. The sensitivity of the questionnaire was 75.0%, and the negative predictive value was 99.7%. CONCLUSIONS: Although the rate of positive PCR results was not significantly different between the groups, the number needed to screen is considerably high. The use of questionnaire‐based PCR testing in areas with low incidence of COVID‐19 allows for a reasonable allocation of resources and is easy to implement.