Nosocomial COVID-19 infection in women undergoing elective cesarean delivery: a prospective cohort study

BACKGROUND: The COVID-19 pandemic placed obstetricians in a difficult position of continuing to perform elective cesarean delivery without the knowledge of the risk of the spread of nosocomial infection of the COVID-19 virus. OBJECTIVE: This study aimed to determine the nosocomial infection rate in women undergoing elective cesarean delivery at 2 academic institutions. STUDY DESIGN: This nonrandomized prospective cohort trial evaluated patients undergoing elective cesarean delivery during the reopening phase of the COVID-19 pandemic in the state of New York at 2 large volume labor and delivery units. Eligible patients with a negative preoperative reverse transcriptase-polymerase chain reaction test and immunoglobulin G antibody test for COVID-19 were retested 6 to 9 days after discharge. The primary objective was the COVID-19 test conversion rate defined as a positive polymerase chain reaction test for SARS-CoV-2 after discharge with a negative preoperative test. This was used as a proxy for the nosocomial infection rate. RESULTS: A total of 136 patients were screened for participation. Of these patients, 2 tested positive for COVID-19 on preoperative testing, and 25 declined to participate. Overall, 111 patients consented to participate, and 96 patients underwent both preoperative and postoperative testing. No patient with a negative polymerase chain reaction test preoperatively, had a positive polymerase chain reaction test for the COVID-19 virus postoperatively. CONCLUSION: With strict and methodical perioperative and postpartum protocols, we can limit nosocomial COVID-19 infection in women undergoing elective cesarean delivery.