Steven Chen1, Peter Bernstein2, Singh Nair3, Erik Romanelli3, Rasha Khoury2, Jacqueline Labins1, Giuseppe Fiorica1, Shamantha Reddy3. 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.
Abstract
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.
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 patientsinfected 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 illpatients. 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.