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Anaesthesiology Intensive Therapy
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2/2021
vol. 53
 
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abstract:
Original paper

A review of 92 obstetric patients with COVID-19 in the Bronx, New York and their peripartum anaesthetic management

Steven Chen
1
,
Peter Bernstein
2
,
Singh Nair
3
,
Erik Romanelli
3
,
Rasha Khoury
2
,
Jacqueline Labins
1
,
Giuseppe Fiorica
1
,
Shamantha Reddy
3

  1. Albert Einstein College of Medicine, Bronx, New York, USA
  2. Department of Obstetrics and Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
  3. Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
Anaesthesiol Intensive Ther 2021; 53, 2: 115–125
DOI: https://doi.org/10.5114/ait.2021.105120
Online publish date: 2021/04/14
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Introduction
The Bronx is a borough of New York City that has been profoundly affected by the COVID-19 pandemic. Limited reports exist discussing the anaesthetic management of obstetric patients infected with COVID-19. We review a cohort of obstetric patients in the Bronx with COVID-19 and report their delivery data, anaesthetic management, and maternal-fetal outcomes.

Material and methods
We reviewed 92 pregnant patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered between 1 February 2020 and 1 May 2020. Medical records were reviewed for patient characteristics, anaesthetic management, and clinical outcomes. Patients were stratified by mode of delivery and COVID-19 disease severity.

Results
Of the 92 deliveries, 49 (53%) were vaginal, 14 (15%) were scheduled caesareans, and 29 (32%) were unscheduled caesareans. 64 patients (70%) were asymptomatic for COVID-19 (mild disease: 18 patients [19%], moderate disease: 7 patients [8%], severe disease: 2 patients [2%], critical disease: 1 patient [1%]). 83 patients (90%) received neuraxial analgesia and/or anaesthesia, with combined spinal-epidural (CSE) and dural puncture epidural (DPE) as the most common techniques. 5 patients (5%) required general anaesthesia (GA) for caesarean delivery, 3 (3%) of whom were intubated for severe or critical COVID-19 disease.

Conclusions
Given the risks associated with SARS-CoV-2 aerosol transmission, GA was avoided in all but the most critically ill patients. CSE and DPE were optimal for minimizing catheter failure rates and risk of conversion to GA. SARS-CoV-2 infection in obstetric patients may be associated with an increased risk for adverse outcomes including preeclampsia, preterm delivery, unscheduled caesarean delivery, and mechanical ventilation.

keywords:

caesarean section, COVID-19, obstetric anaesthesia
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