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Herz-Roiphe R, Kim AY, Kaimal AJ, Goldfarb IT. Utilizing Labour and Delivery for remdesivir infusion for high-risk pregnant and postpartum patients with mild-to-moderate disease during a COVID-19 surge. J Hosp Infect 2022; 129:38-40. [PMID: 35944789 PMCID: PMC9356568 DOI: 10.1016/j.jhin.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - A Y Kim
- Harvard Medical School, Boston, MA, USA; Department of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - A J Kaimal
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - I T Goldfarb
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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Soffer MD, Shook LL, James K, Sawyer MR, Ciaranello A, Mahrouk R, Bernstein SN, Boatin AA, Edlow AG, York-Best C, Kaimal AJ, Goldfarb IT. Protocol-Driven Intensive Outpatient Management of Pregnant Patients With Symptomatic Coronavirus Disease 2019. Open Forum Infect Dis 2020; 7:ofaa524. [PMID: 33241071 PMCID: PMC7665663 DOI: 10.1093/ofid/ofaa524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- M D Soffer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - L L Shook
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K James
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M R Sawyer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Ciaranello
- Department of Internal Medicine, Division of Infectious Disease, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - R Mahrouk
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S N Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A A Boatin
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A G Edlow
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - C York-Best
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A J Kaimal
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - I T Goldfarb
- Department of Obstetrics, Gynecology, and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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