Anesthetic Management of Pregnant Women with COVID-19 in a Tertiary-Level Center

Abstract

Introduction: The results of anesthesiological care are presented as it was provided in a provincial center for obstetric surgery of pregnant patients candidates for a cesarean section and who were ill with COVID-19.

Objective: To show the results of a working stage, under an exceptional epidemiological situation and during the existence of more than one circulating strain of SARS-CoV-2.

Methods: A descriptive, longitudinal and prospective study was carried out. Seventy pregnant women diagnosed with COVID-19 and varying degrees of pulmonary and systemic involvement were included.

Results: Forty-nine (85.96 %) were considered as severe cases, orotracheal general anesthesia was used in 54 (97.73 %), 14 (26.31 %) died postoperatively and one (1.75 %) died during surgery. Of the total, 33 (57.89 %) were ventilated on arrival to the surgical unit and 49 (85.96 %) presented severe hypoxemia on arrival to the operating room. Only 21 (36.84 %) were extubated at the end of the operation and only three regional anesthetic procedures were performed. Respiratory distress in 39 (68.42 %) cases, circulatory failure in 17 (29.82 %) cases and the presence of pericardial effusions in 13 (22.80 %) cases were the associated findings. The time between diagnosis and decision for a cesarean section based on maternal benefit was two days on average.

Conclusions: The results of a working stage under an exceptional epidemiological situation and during the existence of more than one circulating strain of SARS-CoV-2 were shown. Most of the attended patients required invasive ventilation. General anesthesia was the technique to be used. Pulmonary dysfunction in association with cardiocirculatory failure were present conditions that determined the results. Compliance with biosafety measures prevented the staff contagion during the entire period.