Anesthesia and protection in an emergency cesarean section for pregnant woman infected with a novel coronavirus: case report and literature review

Abstract

An outbreak of novel coronavirus pneumonia occurred worldwide since December 2019, which had been named COVID-19 subsequently. It is extremely transmissive that infection in pregnant women were unavoidable. The delivery process will produce large amount of contaminated media, leaving a challenge for medical personnel to ensure both the safety of the mother and infant and good self-protection. Only rare cases of pregnant women with COVID-19 are available for reference. Here, we report a 30-year-old woman had reverse transcription polymerase chain reaction-confirmed COVID-19 at 36 weeks 2 days of gestation. Significant low and high variability of fetal heart rate baseline and severe variable decelerations were repeated after admission. An emergency cesarean section at 37 weeks 1 day of gestation under combined spinal and epidural anesthesia was performed with strict protection for all personnel. Anesthesia and operation went uneventfully. None of the participants were infected. We can conclude that when confronted with cesarean section in parturient with COVID-19, careful planning and detailed preparation can improve the safety of the mother and infant and reduce the risk of infection for medical staff to help preventing and controlling the epidemic.

Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study

“…55 Although this was not analysed directly with respect to postoperative outcomes, we found that nine of the studies reported conducting surgical procedures in negative pressure operating rooms. 19,21,22,24,28,29,35,36,38 Negative pressure rooms are commonly used in infection control and ensure that air continually flows into the room, rather than the surrounding area. However, most hospitals only have a limited number of negative pressure operating rooms and therefore have to adapt additional rooms for this purpose.…”

“…Patient use of PPE was poorly reported, with only nine studies stating that patients wore any protection. 19,21e23,28,29,35,38,39 Six of these reported the use of surgical masks only, 19,21,22,28,35,38 with N95 mask respirators specifically mentioned in three studies. 21,22,28 HCW use of PPE was more comprehensively reported, with 16 studies describing perioperative use.…”

“…19,21e23,28,29,35,38,39 Six of these reported the use of surgical masks only, 19,21,22,28,35,38 with N95 mask respirators specifically mentioned in three studies. 21,22,28 HCW use of PPE was more comprehensively reported, with 16 studies describing perioperative use. 19,22e31,35e38,41 Reported type of PPE used by HCWs was wide-ranging with N95 mask respirators, disposable surgical caps, medical goggles or positive-pressure headgear, and disposable protective clothing, gloves, and shoes/shoe covers described.…”

“…Nine of the studies in our review reported using operating rooms with negative pressure. 19,21,22,24,28,29,35,36,38 Only one of these studies also described the postoperative care of a patient in a negative pressure ICU, 24 although two studies described sending neonates to negative-pressure wards immediately after birth. 29,31 However, details on other elements of ventilation such as air changes per hour, direction, and filtration were lacking.…”

“…This also appears to be supported by eight of the other nine studies where no HCW SARS-CoV-2 infections were reported when using PPE. 19,22e24,28,30,35,37 Three of these studies reported level 3 PPE, 22,30,37 one reported biosafety level 3, 19 and four studies described PPE in detail including N95 masks, eye goggles, face shields, and surgical gowns. 23,24,28,35 However, we can only make tentative recommendations on the use of PPE as it was not clearly reported how long PPE was worn before, during, and/or after the surgery, and whether any changes were made to the level of PPE worn at any stage (e.g.…”