Utility of lung ultrasound assessment for probable SARS‐CoV‐2 infection during pregnancy and universal screening of asymptomatic individuals

• DOI: 10.1002/uog.23099
• Publication Date: 2020-09-27T06:54:12Z
• Authors: E. Kalafat; M. Yassa; A. Koc; N. Tug
• Keywords: Adult; Turkey; Pneumonia, Viral; Betacoronavirus; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Obstetrics and Gynaecology; Prevalence; Humans; Pregnancy Complications, Infectious; Asymptomatic Infections; Lung; Pandemics; Retrospective Studies; Ultrasonography; Radiological and Ultrasound Technology; SARS-CoV-2; COVID-19; General Medicine; Hospitalization; Reproductive Medicine; Radiology Nuclear Medicine and imaging; Female; Risk Adjustment; Coronavirus Infections

Pregnant women are a risk group for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which has been shown to be associated with increased rates of preterm delivery and Cesarean section1. Despite reassuring safety profile, imaging modalities, such as computed tomography, used scarcely in pregnancies suspected SARS-CoV-2 infection due concerns about undue exposure the fetus ionizing radiation. However, false-positive false-negative results not uncommon reverse transcription polymerase chain reaction (RT-PCR) testing. Anecdotal reports suggest that adjunct use modalities can help manage cases molecular testing clinical presentation conflicting2. Furthermore, is suggested preoperative screening emergency cases3. Lung ultrasound (LUS) an ionizing-radiation-free, reproducible modality evaluating lung lesions, its readily available, well advance RT-PCR results4. added benefit LUS managing symptomatic asymptomatic patients during pregnancy remains unclear. This was retrospective cohort study conducted two large pandemic hospitals Turkey (Ankara University Hospital, Ankara, Sancaktepe Training Istanbul). Asymptomatic pregnant admitted evaluated probable between May June 2020 were included. Patients fever, cough, shortness breath, loss taste or smell, fatigue considered symptomatic. living same household person diagnosed exposed. All using LUS. Posterior, basal lateral portions maternal lungs examined videoclips stored offline evaluation. The obstetricians performing examinations received brief training course on saved images subject quality control measures4. Two researchers (E.K., M.Y), who blinded patients, scored anonymized videoclips. area highest score analysis (Table S1)5. utility symptoms history predicting positive test result assessed mixed-effects binomial regression varying intercepts. predictive value models without compared. We included 601 study, whom 82 (13.6%) had infection. characteristics findings both groups presented Table 1. addition scoring baseline model consisting symptoms, body mass index improved significantly prediction (log-likelihood, –18.1; df, 3; P < 0.001). additional weaker –4.523; = 0.028) comparison −14.8; In cases, under receiver-operating-characteristics curve (AUC) from 0.93 (95% CI, 0.88–0.99) 0.95 0.90–1.00) scoring, albeit change statistically significant (P 0.252). AUC 0.001) 0.76 0.65–0.88) (Figure 1). women, 77.1% 67.0–84.8%) 93.7% 83.7–97.8%) negative 77.4% 62.6–87.5%) 80.6% 66.0–89.9%) scoring. would diagnose 24.0 (interquartile range, 18.0–30.0) infections per 100 compared alone. could facilitate early diagnosis projected second peak closing have proved very useful stages when availability limited. rationing resources waiting option (e.g. urgent elective procedures) capacity strained. Strengths our include data prevalence assessment Our limited by lack external validation required expertise perform assessment6. acknowledge work TUrkish Pregnancy (TULIP) collaboration members. full list members participated this project found tulipcollaboration.com Appendix S1. support available corresponding author upon reasonable request. Please note: publisher responsible content functionality any supporting information supplied authors. Any queries (other than missing content) should directed article.