The impact of anesthesia choice on maternal and fetal outcomes in pregnant women with COVID-19 undergoing cesarean section

Objective: Cesarean section (C/S) is frequently considered by the obstetricians for delivery in pregnant women with COVID-19. However, there is little data concerning the mode of anesthesia, whether general (G) or regional (R). This study aimed to compare general and regional anesthesia concerning the maternal and fetal outcomes in pregnant COVID-19 women undergoing C/S. Methods: Twenty-three consecutive pregnant women with COVID-19 admitted for delivery with C/S in our institute were enrolled in this retrospective analysis. All C/S procedures and anesthesia were performed by the same surgical team and the anesthesiologist. Subjects were divided into two groups according to the anesthesia procedure which was left to the anesthesiologist’s and obstetrician’s discretion. The difference in laboratory tests, length of hospital stay, maternal ICU admission, and 1st and 5th minute APGAR scores was the primary outcome measure of this study. Results: There were no significant difference s between the groups concerning fever, oxygen saturation, D-dimer, ferritin, C-reactive protein, leukocyte count, mean platelet volume and neutrophil to lymphocyte ratio. However, subjects receiving general anesthesia had higher procalcitonin at admission (1.2 ± 0.5, ng/mL vs. 0.6 ± 0.4, ng/mL, p=0.010). However, length of hospital stay was significantly longer in subjects receiving general anesthesia compared to those receiving regional anesthesia (18.5 ± 6.2 days vs. 12.6 ± 4.2 days, p=0.016). Moreover, 1st (6.1 ± 0.8 vs. 7.6 ± 0.5, p=0.011) and 5th minute (7.2 ± 1.4 vs. 8.9 ± 1.3, p=0.026) APGAR scores of the neonates born to mothers receiving general anesthesia were significantly lower compared to those born to mothers receiving regional anesthesia. Conclusions: Both regional and general anesthesia provide similar changes in surrogate markers of inflammation, and D-dimer. The length of the hospital stay was significantly higher in women undergoing C/S with general anesthesia compared to women receiving regional anesthesia during C/S. Moreover, the 1st and 5th minute APGAR scores were significantly lower in neonates born to mothers undergoing C/S with general anesthesia compared to women receiving regional anesthesia during C/S.

Keywords:

COVID-19, pregnancy, cesarean general anesthesia, regional anesthesia,

PDF

___

1. Velavan TP, Meyer CG: The COVID‐19 epidemic. Tropical medicine & international health 2020, 25(3):278.
2. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL: Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. American journal of obstetrics and gynecology 2020, 222(6):521-531.
3. Rasmussen SA, Jamieson DJ: Coronavirus disease 2019 (COVID-19) and pregnancy: responding to a rapidly evolving situation. Obstetrics and gynecology 2020.
4. Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G: Viral infections during pregnancy. American journal of reproductive immunology 2015, 73(3):199-213.
5. Mor G, Cardenas I: The immune system in pregnancy: a unique complexity. American journal of reproductive immunology 2010, 63(6):425-433.
6. Luppi P: How immune mechanisms are affected by pregnancy. Vaccine 2003, 21(24):3352-3357.
7. James AH: Pregnancy-associated thrombosis. ASH Education Program Book 2009, 2009(1):277-285.
8. Ortiz EI, Herrera E, De La Torre A: Coronavirus (COVID 19) Infection in Pregnancy. Colombia Médica 2020, 51(2).
9. Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, Zheng C: Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. American journal of roentgenology 2020, 215(1):127-132.
10. Páez L JJ, Navarro V JR: Regional versus general anesthesia for cesarean section delivery. Colombian Journal of Anestesiology 2012, 40(3):203-206.
11. Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM: Anesthesia-related maternal mortality in the United States: 1979–2002. Obstetrics & Gynecology 2011, 117(1):69-74.
12. Wahba R: Perioperative functional residual capacity. Canadian Journal of Anaesthesia 1991, 38(3):384-400.
13. Hedenstierna G, Rothen HU: Respiratory function during anesthesia: effects on gas exchange. Comprehensive Physiology 2011, 2(1):69-96.
14. Strandberg Å, Tokics L, Brismar B, Lundquist H, Hedenstierna G: Atelectasis during anaesthesia and in the postoperative period. Acta Anaesthesiologica Scandinavica 1986, 30(2):154-158.
15. Don H: The mechanical properties of the respiratory system during anesthesia. International anesthesiology clinics 1977, 15(2):113-136.
16. Hedenstierna G, Edmark L: Mechanisms of atelectasis in the perioperative period. Best Practice & Research Clinical Anaesthesiology 2010, 24(2):157-169.
17. Lindberg P, Gunnarsson L, Tokics L, Secher E, Lundquist H, Brismar B, Hedenstierna G: Atelectasis and lung function in the postoperative period. Acta Anaesthesiologica Scandinavica 1992, 36(6):546-553.