Obstetrical Unit Response to the COVID-19 Pandemic: OUR Study

Objective :This study aimed to describe the response of labor and delivery (L and D) units in the United States to the novel coronavirus disease 2019 (COVID-19) pandemic and determine how institutional characteristics and regional disease prevalence affect viral testing and personal protective equipment (PPE). Study Design A cross-sectional survey was distributed electronically through the Society for Maternal-Fetal Medicine e-mail database (n = 584 distinct practices) and social media between April 14 and 23, 2020. Participants were recruited through snowballing. A single representative was asked to respond on behalf of each L and D unit. Data were analyzed using Chi-square and Fisher's exact tests. Multivariable regression was performed to explore characteristics associated with universal testing and PPE usage. Results A total of 301 surveys (estimated 51.5 response rate) was analyzed representing 48 states and two territories. Obstetrical units included academic (31), community teaching (45) and nonteaching hospitals (24). Sixteen percent of respondents were fromstates with high prevalence, defined as higher deaths per million rates compared with the national average. Universal laboratory testing for admissions was reported for 40 (119/297) of units. After adjusting for covariates, universal testing was more common in academic institutions (adjusted oddsratio [aOR] = 1.73, 95 confidence interval [CI]: 1.23-2.42) and high prevalence states (aOR = 2.68,95 CI: 1.37-5.28). When delivering asymptomatic patients, full PPE (including N95 mask) was recommended for vaginal deliveries in 33 and for cesarean delivery in 38 of responding institutions. N95 mask use during asymptomatic vaginal deliveries remained more likely in high prevalence states (aOR = 2.56, 95 CI: 1.29-5.09) and less likely in hospitals with universal testing (aOR = 0.42, 95 CI: 0.24-0.73). Conclusion Universal laboratory testing for COVID-19 is more common at academic institutions and in states with high disease prevalence. Centers with universal testing were less likely torecommend N95 masks for asymptomatic vaginal deliveries, suggesting that viral testing can play a role in guiding efficient PPE use. Key Points Heterogeneity is seen in institutional recommendationsfor viral testing and PPE. Universal laboratory testing for COVID-19 is more common at academic centers. N95 mask use during vaginal deliveries is less likely in places with universal testing.