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

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic presented unprecedented challenges to healthcare systems globally.
• Labor and delivery units (L&D) faced unique demands in managing patient care while mitigating viral transmission.
• Understanding institutional responses to testing and personal protective equipment (PPE) protocols is crucial for optimizing obstetric care during pandemics.

Purpose of the Study:

• To describe the response of US L&D units to the COVID-19 pandemic.
• To determine how institutional characteristics and regional disease prevalence influenced viral testing and PPE strategies.
• To identify factors associated with universal COVID-19 testing and N95 mask usage in L&D settings.

Main Methods:

• A cross-sectional electronic survey was distributed to L&D units across the US.
• Data were collected from April 14-23, 2020, with snowball sampling for participant recruitment.
• Statistical analyses included Chi-square, Fisher's exact tests, and multivariable regression to identify factors associated with testing and PPE use.

Main Results:

• A total of 301 L&D units responded, representing 48 states and two territories.
• Universal COVID-19 laboratory testing for admissions was implemented in 40% of units, being more prevalent in academic institutions and high-prevalence states.
• N95 mask recommendation for asymptomatic vaginal deliveries was less likely in units with universal testing, suggesting a potential role for testing in guiding PPE allocation.

Conclusions:

• Institutional characteristics, particularly academic affiliation, and regional disease prevalence significantly impact COVID-19 testing policies in L&D units.
• Universal testing was associated with decreased N95 mask recommendations for asymptomatic vaginal deliveries, indicating that testing can optimize PPE utilization.
• Significant heterogeneity exists in L&D unit responses to the pandemic regarding viral testing and PPE, highlighting the need for evidence-based guidelines.