Journal of Obstetric Anaesthesia and Critical Care (Jan 2022)

Retrospective analysis of the outcome of the anaesthetic procedures in COVID-19 parturient undergoing cesarean delivery in a tertiary care hospital in Delhi, India

  • Bharti Wadhwa,
  • Prachi Gaba,
  • Kapil Chaudhary,
  • Kirti N Saxena,
  • Kavita R Sharma,
  • Mousumi Saha,
  • Saurabh Gaur,
  • Pallavi Doda

DOI
https://doi.org/10.4103/JOACC.JOACC_93_21
Journal volume & issue
Vol. 12, no. 2
pp. 144 – 149

Abstract

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Context: The effect of coronavirus disease 2019 (COVID-19) on a parturient undergoing cesarean delivery (CD) is not fully understood. Aims: To evaluate anesthetic management of a COVID parturient undergoing CD. Settings and Design: Tertiary care hospital, retrospective analysis. Methodology: Hospital case record files of COVID-19 parturients who underwent CD were reviewed with respect to clinical presentation, anesthetic technique, peri-operative course, and maternal-fetal outcome. Data Analysis: Continuous variables are reported as mean ± SD or median (range) and categorical variables as numbers (percentages). Results: Hundred COVID-19 parturients underwent CD: Ninety-eight parturients had asymptomatic to mild clinical presentation, whereas two had a severe presentation. Raised liver enzymes, raised D-dimer, and thrombocytopenia were observed in 65, 34, and 11 parturients, respectively. Combined spinal-epidural anesthesia (CSEA), subarachnoid block (SAB), and general anesthesia were administered in 72, 26, and 2 parturients, respectively. Meantime to administration of SAB and CSEA were 23.5 ± 3.2 min and 28.4 ± 2.8 min, respectively. Adequate block height for CD was achieved in all parturients. Post-spinal hypotension that responded promptly to fluids and vasopressors was reported in six parturients. Postoperatively, two parturients required intensive care unit (ICU) care with one maternal mortality. None of the neonates tested positive for COVID-19. Three neonates had a low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) at 5 min with one neonatal mortality. Conclusions: Neuraxial anesthesia seems to be a safe and preferred anesthetic technique for CD in a COVID-19 parturient. The incidence of post-spinal hypotension is low and responds promptly to treatment. The course of neuraxial anesthesia and the neonatal outcome is unaffected by the COVID-19 status of the patient.

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