Anesthesia for cesarean section and SARS Cov-2: Observational study in Peru

Keywords: COVID-19, neuraxial anesthesia, SARS-CoV-2, Pregnancy, Cesarean section

Abstract

Introduction: Information regarding the clinical behavior and the anesthetic and perioperative management in pregnant patients with SARS-CoV-2 is starting to appear in the literature in the form of case reports or case series. However, strong evidence and recommendations are still limited.

Objective: To describe the clinical characteristics, the results of anesthetic and perioperative management, and complications in seroprevalent pregnant women for SARS-CoV-2 infection, delivered by cesarean section.

Methodology: Observational study in which 107 clinical records of pregnant women who were seroprevalent for SARS-CoV-2 infection were reviewed and analyzed between April and June, 2020. Demographic, clinical and serological data were collected, as well as data on the anesthetic technique and intraoperative and postoperative complications.

Results: Of the 107 pregnant women with SARS-CoV-2 infection, 99 (92.52%) were asymptomatic and 8 (7.48%) had mild symptoms. The most frequent reasons for cesarean section were cephalo-pelvic disproportion in 20 (18.68%), previous cesarean section in 20 (18.68%) and non-reassuring fetal status in 14 (13.08%). Anesthesia technique was neuraxial in all cases, with spinal used in 100 (93.5%), combined spinal-epidural in 4 (3.7%) and epidural catheter in 3 (2.8%) patients. No deaths had occurred until the third postoperative day of follow-up.

Conclusions: The majority of pregnant women with SARS-CoV-2 infection are asymptomatic. In this work, spinal, combined spinal-epidural and epidural neuroxial anesthesia techniques were shown to be effective and safe for these patients and their newborn babies.

References

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. doi: http://www.doi.org/10.1016/j.ajog.2020.04.005

Omer S, Ali S, Din Babar Z. Preventive measures and management of COVID-19 in pregnancy. Drugs Ther Perspect. 2020;1-4. doi: http://www.doi.org/10.1007/s40267-020-00725-x

Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. doi: http://www.doi.org/10.1136/bmj.m2107

Khalil A, Kalafat E, Benlioglu, O´Brien P, Morris E, Draycott T, et al. SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes. E Clinical Medicine. 2020;25. doi: http://www.doi.org/10.1016/j.eclinm.2020.100446

Gao Yj, Ye L, Zhang Js, Yin Yx, Liu M, Yu H, et al. Clinical features and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. BMC Infectious Diseases. 2020;20(1):564. doi: http://www.doi.org/10.1186/s12879-020-05274-2

Flannery DD, Gouma S, Dhudasia MB, Mukhopadhyay S, Pfeifer MR, Woodford EC, et al. SARS-CoV-2 seroprevalence among parturient women. MedRxiv Prepr Serv Health Sci. 2020. doi: http://www.doi.org/10.1101/2020.07.08.20149179

Vidal-Anzardo M, Solis G, Solari L, Minaya G, Ayala-Quintanilla B, Astete-Cornejo J, et al. Evaluación en condiciones de campo de una prueba rápida para detección de anticuerpos IgM e IgG contra SARS-CoV-2. Rev Peru Med Exp Salud Pública. 2020;37(2):203-9. doi: http://www.doi.org/10.17843/rpmesp.2020.372.5534

Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020. doi: http://www.doi.org/10.1016/j.jinf.2020.02.028

Chen R, Zhang Y, Huang L, et al. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020;67(6):655-63. doi: http://www.doi.org/10.1007/s12630-020-01630-7

Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul-Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. Int J Gynaecol Obstet. 2020;151(1):7-16. doi: http://www.doi.org/10.1002/ijgo.13329

Zhong Q, Liu YY, Luo Q, Zou YF, Jiang HX, Li H, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study. Br J Anaesth. 2020;124(6):670-5. doi: http://www.doi.org/10.1016/j.bja.2020.03.007

Yue L, Han L, Li Q, Zhong M, Wang J, Wan Z, et al. Anesthesia and infection control in cesarean section of pregnant women with COVID-19 infection: A descriptive study. J Clin Anesth. 2020;66:109908. doi: http://www.doi.org/10.1016/j.jclinane.2020.109908

Bauer ME, Bernstein K, Dinges E, et al. Obstetric anesthesia during the COVID-19 pandemic. Anesth Analg. 2020;131(1):7-15. doi: http://www.doi.org/10.1213/ANE.0000000000004856

Landau R, Bernstein K, Mhyre J. Lessons learned from first COVID-19 cases in the United States. Anesth Analg. 2020;131(1):e25-6. doi: http://www.doi.org/10.1213/ANE.0000000000004840.

Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99(7):823-9. doi: http://www.doi.org/10.1111/aogs.13867.

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320. doi: http://www.doi.org/10.1136/bmj.m3320

D’Souza R, Malhamé I, Teshler L, Acharya G, Hunt BJ, McLintock C. A critical review of the pathophysiology of thrombotic complications and clinical practice recommendations for thromboprophylaxis in pregnant patients with COVID-19. Acta Obstet Gynecol Scand. 2020;99(9):1110-20. doi: http://www.doi.org/10.1111/aogs.13962

PAHO. Laboratory guidelines for the detection and diagnosis of COVID-19 virus infection [Internet]. 2020 [citado: 2021 feb. 5]. Disponible en: https://iris.paho.org/bitstream/handle/10665.2/52458/PAHOIMSPHECOVID-19200038_eng.pdf?sequence=1&isAllowed=y

How to Cite
1.
Huayanay Bernabé ME, Calderón Lozano ML, Moreno Gonzáles Álvaro R, Vásquez Rojas JG. Anesthesia for cesarean section and SARS Cov-2: Observational study in Peru. Colomb. J. Anesthesiol. [Internet]. 2021Jul.27 [cited 2021Oct.25];49(4). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/998

Downloads

Download data is not yet available.
Published
2021-07-27
How to Cite
1.
Huayanay Bernabé ME, Calderón Lozano ML, Moreno Gonzáles Álvaro R, Vásquez Rojas JG. Anesthesia for cesarean section and SARS Cov-2: Observational study in Peru. Colomb. J. Anesthesiol. [Internet]. 2021Jul.27 [cited 2021Oct.25];49(4). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/998
Section
Original

More on this topic