Güneş Özlem YILDIZ, Zafer ÇUKUROVA, Gülsüm Oya HERGUNSEL, Elif MARANGOZ

The Management of Anaesthesia in Caesarean Section of Pregnant Women with COVID-19

Objective: In this study, we aimed to investigate the effect of preoperative clinical status on the choice of anesthesia method and the postoperative maternal and fetal outcomes in the caesarean section of pregnant women with COVID-19 related acute respiratory distress syndrome. Materials and Methods: Pregnant women with COVID-19 related acute respiratory distress syndrome, for whom caesarean sections were planned, were included in this retrospective study. Clinical features, preoperative findings and treatments, maternal and fetal outcomes in the preoperative period, intensive care needs, and hospital stay were evaluated. Results: Ten patients who underwent caesarean section were included in the study. The mean age of the patients was 34±1.82 and the mean gestational week was 33.1±3.88. Chronic disease was present in 44.4% of them. Sixty percent of the patients were admitted to the postoperative intensive care unit. Eighty percent of the newborns were preterm and half of the newborns needed intensive care unit hospitalization. Conclusion: The clinical features of pregnant women with COVID-19 are similar to those reported for non-pregnant adults with COVID-19, but respiratory parameters of pregnant women with COVID-19 related acute respiratory distress syndrome deteriorate rapidly and should be monitored closely. Preoperative clinic status and oxygenation are the most important determinants in the selection of anesthesia type for the caesarean section.

PDF

___

[1]Ashokka B, Loh MH, Tan CH, et al. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol. 2020; 223(1): 66-74.e3.

[2]Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence. Int J Antimicrob Agents. 2020; 55(6): 105948.

[3]Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J. Med. Virol. 2020; 92(6): 548-551.

[4]Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratory distress syndrome in coronavirus disease 2019–infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol MFM. 2020; 2(3): 100120.

[5]Panahi L, Amiri M, Pouy S. Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review. Arch Acad Emerg Med. 2020; 8(1): e34.

[6]Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506.

[7]Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004; 191(1): 292-297.

[8]Yu N, Li W, Kang Q, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020; 20(5): 559-564.

[9]Breslin N, Baptiste C, Gyamfi-Bannerman C, et al. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020; 2(2): 100118.

[10]Chung M, Bernheim A, Mei X, et al. CT imaging features of 2019 novel coronavirus (2019-NCoV). Radiology. 2020; 295(1): 202-207.

[11]Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9(1): 51-60.

[12]Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) Pneumonia: A preliminary analysis. Am J Roentgenol. 2020; 215(1): 127-132.

[13]Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020; 323(11): 1061-1069.

[14]Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229): 1054-1062.

[15]Li X, Ma X. Acute respiratory failure in COVID-19: Is it “typical” ARDS? Crit. Care. 2020; 24(1): 198.

[16]Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal. J. Hear. Lung Transplant. 2020; 39(5): 405-407.

[17]Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395(10226): 809-815.

[18]Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J. Infect. 2020.

[19]Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020; 2(2): 100107.