Accuracy of screening methods of COVID-19 in pregnancy: a cohort study

BACKGROUND: All pregnant women in labor should be universally screened for Coronavirus Disease 2019 (COVID- 19) during pandemic periods using reverse transcriptase polymerase chain reaction (RT -PCR) test. In many lowmiddle income countries, screening method was developed as an initial examination because of limited availability of RT -PCR tests. This study aims to evaluate the screening methods of COVID-19 accuracy in pregnant women. METHODS: We recruited all pregnant women with suspicion of COVID-19 from April to August 2020 at Airlangga University Hospital, Surabaya, Indonesia. The participant was divided into two groups based on RT -PCR results: COVID-19 and non-COVID-19 group. The proportion of positive signs and symptoms, rapid antibody test, abnormal findings in chest X-ray, and neutrophil to lymphocyte ratio (NLR) value were then compared between both groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and diagnostic accuracy (DOR) were calculated. RESULTS : A total 141 pregnant women with suspected COVID-19 cases were recruited for this study. This consist of 62 COVID-19 cases (43.9%) and 79 non-COVID-19 pregnant women (56.1%). The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of each parameter are as follow: clinical sign and symptoms (24.19%, 75.95%, 3.92%, 96.11%, 65.87%), rapid antibody test (72.73%, 35.06%, 4.35%, 96.94%, 36.53%), chest X-ray (40.68%, 59.45%, 3.92%, 96.11%, 58.76%), and NLR >5.8 (41.38%, 72%, 5.66%, 96.80%, 70.81%). CONCLUSIONS: The use of combined screening methods can classify pregnant women with high-risk COVID-19 before definitively diagnosed with RT-PCR. This practice will help to reduce RT-PCR need in a limited resources country.