Table 1. Diagnostic studies for obstetrics patients with condition warranting admission for COVID-19.
| Diagnostic studies | Recommended patients | Clinical rationale |
|---|---|---|
| CBC and differential | All patients | Leukopenia/lymphopenia common |
| Basic metabolic panel | All patients | Assess renal function |
| Transaminases and bilirubin | All patients | Baseline assessment may inform medication choices |
| Ferritin | All patients | Trend may inform prognosis |
| PT-INR, PTT, fibrinogen, D-dimer | All patients | Assess for coagulopathy (low or normal fibrinogen can be first sign of DIC in pregnancy), D-dimer trend in VTE evaluation |
| Troponin | Concern for cardiac disease | Evaluate baseline cardiac status (CK secreted by placenta, not reliable) |
| C-reactive protein | Consider in admitted patients with severe disease | Elevated in pregnancy but trend may inform treatment response in severe disease |
| Urinalysis and urine culture | Admitted febrile patients | Evaluate for alternate explanation for fever or superimposed infection |
| Blood cultures | Admitted febrile patients | Evaluate for alternate explanation for fever or superimposed infection |
| Chest X-ray | Admitted febrile patients or with shortness of breath | Evaluate for pneumonia |
| Electrocardiogram | Patients with tachycardia or severe disease | Obtain to establish baseline, some medications cause QT prolongation |
| Chest computed tomography | Clinical scenario where results may change management (concern for pulmonary embolism) | Chest CT safe in pregnancy but may be technically limited in cases of tachypnea |
| Transthoracic echocardiogram | Concern for cardiac disease or objective evidence of cardiovascular insult (shock refractory tachycardia, elevated troponin) | Evaluate for myocardial damage secondary to COVID or raise concern for cardiogenic pulmonary edema or cardiogenic shock related to COVID, pregnancy, or both |
Abbreviations: CBC, complete blood count; CK, creatine kinase; COVID, coronavirus disease; DIC, disseminated intravascular coagulation; PT-INR, prothrombin time-international normalized ratio; PTT, partial thromboplastin time; VTE, venous thromboembolism.