COVID testing question

[mgriffiths]

In this time of uncertainty and crisis, I have a question about whether you would push to test the patients described below:

31yo currently pregnant female P2G1001 without respiratory symptoms and without any significant medical history other than PCOS.  At 36 weeks and 6 days baby is found stillborn in utero.  First pregnancy had zero complications with healthy baby born at term.  No family history of chromosomal or clotting disorders (known back at minimum 3 generations and all extended family).  History of 1 known miscarriage at approximately 14 weeks by father's sister, but sister has 6 healthy children with normal pregnancies otherwise.  Father's brother has 3 healthy children.  No other family history of known miscarriage in either mothers or any grandmothers.

Would you test the mother and/or the child for COVID?

[DarwinStarwin]

I don't know. I would probably bounce that question off an ID person.

[mgriffiths]

They've changed course, they have approved and completed the test on this patient.

[wilso2ar]

How devastating for that family.  And if this is someone close to you, I am very sorry for your loss. 

[Reality Check 2]

My heart hopes this wasn’t your wife and daughter. 
Words aren’t enough.

May peace find you.

[Guest ERCat]

I would absolutely not test the patient for COVID-19. This wouldn’t even be considered in my hospital. Clinically I don’t think it makes sense (but would like to hear rationale for why it does make sense?)

VERY very sad scenario. 

[ventana]

nope, no way

 

your first question assumes that we have a good test (Which we do not)

I am no OB but I don't see the utility in testing even if we had a good test (Which we do not)

 

if there is not a direct causal link to the test why bother ordering it?  Also, how would it change the clinical management at this time?

 

 

(disclaimer - I have just about zero OB knowledge other then no ASA and avoid NSAIDS)

[Reality Check 2]

I would test for knowledge sake.

Peace of mind, education, knowledge of the potential affect of the virus.

We need all the information we can get for the future.

Remember Zika.

[mgriffiths]

The rationale behind testing is for two reasons:

1. Healthcare should know if there is a potential link between covid positive mother and loss of baby in utero. Especially with reports of odd strokes associated with covid and other clotting abnormalities in otherwise healthy, young patients.

2. On a more patient specific note, it is considered best practice to try to find an answer for loss of pregnancy, especially at term to hopefully be able to make informed decisions for possible future pregnancies. Of course the decision for testing options is up to the parents (such as fetal biopsies and/or autopsy).

 

Of course, the question of covid test accuracy is valid.

 

In this case the covid test was negative, of course accuracy (sensitivity/specificity) could be questioned...but it’s what we have. In regards to this patient the answer was found to be most likely a silent placental abruption based on bloodwork and findings at delivery.

 

For those that have guessed this was my wife and family, unfortunately that is correct. I wasn’t trying to specifically post to make that clear, but it’s not a problem.  The post honestly was made while angry the test was denied.  But, the reality is that this stuff happens, and us highly educated healthcare providers aren’t spared simply because we know lots about healthcare and best practices. It doesn’t make it easier for me or my wife, but it’s reality. We were the unlucky ones.

Thank you for your thoughts and prayers. I hope you all can understand if I don’t respond to questions immediately or at all regarding the situation. Pretty much all of the pertinent details are here.

Edited April 30, 2020 by mgriffiths

[Reality Check 2]

Many blessings to you and your family.

We are harder on ourselves as medical professionals but we are just as subject to loss as others. And it is harder for us to accept sometimes. I have been there and understand.

My peace come to you. 

[ventana]

21 hours ago, Reality Check 2 said:

I would test for knowledge sake.

Peace of mind, education, knowledge of the potential affect of the virus.

We need all the information we can get for the future.

Remember Zika.

But what about the fact the tests sensitivity and specificity stink, like in the toilet bad..... 

 

Zika also had a direct effect on fetus and i think future preg, so that is relevant.

 

Testing for COVID with a cruddy test for knowledge sake seems unwise (when the knowledge gained is very possibly flawed) 

[GetMeOuttaThisMess]

C'mon Ven!  You know we need to screen!  Don't get caught up in something as silly as the reliability of the test.  OK, now to be serious for a second.  I swear that one of these days people will start to pay attention to PPV/NPV, sensitivity/specificity.  These test results are only valid if they provide us with usable information.  Unfortunately for us, the ones that do understand the concept and the importance of same are the ones being shouted over.  Otherwise, we're spinning our wheels and giving the national news outlets something to falsely grab a hold of.