Approach to Intrapartum Fever During the COVID-19 Pandemic: A New York City Hospital Experience [ID: 1377237

Abstract

INTRODUCTION: At the start of the COVID-19 pandemic, repeat testing for SARS-CoV-2 was added to the management of intrapartum fever. Mother–newborn isolation and separation were implemented until repeat results were available and negative. As few data exist to support or refute repeat testing in this setting, we assessed the yield of repeat testing for intrapartum fever. METHODS: We performed a retrospective, IRB-exempt, study from October 2020 to June 2022 of patients who had a negative SARS-CoV-2 test at admission and developed intrapartum fever without an alternative explanation for the fever. Maternal and newborn demographic and clinical variables were extracted from electronic medical records. RESULTS: During the study period, among 3,236 deliveries, 151 (4.7%) patients (median age, 34 years) had intrapartum fever; 43%, 11%, and 37% were Asian, Black, and White: 17% were Hispanic. All delivered live newborns (median gestational age, 39 weeks). The median time to fever after admission was 19 hours (range, 0.17–46.17 hours), the median fever was 38.3°C, and median time to repeat test result was 2.07 hours (range, 0.42–12.70 hours). On repeat testing, one (0.7%) patient was positive for SARS-CoV-2 and two had other respiratory viruses detected. Less than 1% had COVID symptoms other than fever. Nine percent of newborns needed transient respiratory support. Two newborns were tested for SARS-CoV-2; both were negative. CONCLUSION: Repeat SARS-CoV-2 testing for intrapartum fever management resulted in one additional case, suggesting that routine repeat testing in patients with intrapartum fever and no other symptoms is generally not needed. Additionally, in this setting, mother–newborn isolation and separation are not warranted.