Obstetric analgesia and anaesthesia in SARS‐CoV‐2‐positive parturients across 10 maternity units in the north‐west of England: a retrospective cohort study

Abstract

Since the start of the COVID-19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS-CoV-2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS-CoV-2 across 10 hospitals in the north-west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS-CoV-2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID-19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64-1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6-96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64,; p = 0.002); of Asian ethnicity (OR 1.54, 1.04-2.28; p = 0.03); to deliver prematurely (OR 2.16,; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16-2.12; p = 0.008); and a higher critical care utilisation rate both pre-(8% vs. 0%, p = 0.001) and post-delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83-6.52; p = 0.001). Eight neonates tested positive for SARS-CoV-2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78-1.57; p = 0.55). In women with COVID-19, non-neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID-19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.

Neuraxial Anesthesia during the COVID-19 Pandemic: Report from a Large Academic Medical Center

“…A large retrospective cohort study from northwest England encompassing ten hospitals and 57,800 births showed that the labor epidural anesthesia rate was not significantly increased or decreased due to the COVID-19 pandemic. 16 This was a similar finding in our study, which did not find a significant difference in the overall numbers of neuraxial placed. Patkar-Kattimani et al also described no significant difference in the number of labor epidural analgesia techniques performed before and during the pandemic in a tertiary maternity center in the UK.…”

Critical care, maternal and neonatal outcomes of pregnant women with COVID‐19 admitted to eight intensive care units during the wildtype, alpha and delta waves of the pandemic across the North West of England—a retrospective review

“…Data from the UK Obstetric Surveillance System (UKOSS) reported ICU admission rates during pregnancy varying from 7.9% to 16% during the wildtype, alpha and delta waves of the pandemic, whereas during the omicron wave, the ICU admission rate declined to 3% 8,9 . Our previous work reporting anesthetic outcomes in women who tested positive for SARS‐CoV‐2 in the North West of England, highlighted ICU admission rates of 8% during the antepartum period, increasing to 11% postpartum 4 . Critical care outcomes and maternal morbidity of these women affected by SARS‐CoV‐2 and admitted to ICU in the UK are limited to small case series 10 .…”

“…1 Multiple studies in symptomatic pregnant women affected by SARS-CoV-2 across the globe have described significant maternal morbidity, including higher hospitalization rate, cesarean birth, preterm birth, intensive care unit (ICU) admission and the receipt of mechanical ventilation. [2][3][4][5][6][7][8] The ICU admission rate in symptomatic pregnant women with coronavirus disease 2019 in the United Kingdom (UK) has varied throughout the course of the pandemic. Data from the UK Obstetric Surveillance System (UKOSS) reported ICU admission rates during pregnancy varying from 7.9% to 16% during the wildtype, alpha and delta waves of the pandemic, whereas during the omicron wave, the ICU admission rate declined to 3%.…”

Coronavirus Disease-2019 in Pregnancy

“…The liberal use of neuraxial labor analgesia may reduce the need for emergency general anesthesia. 61 A systematic review found an association between having a cesarean section and being admitted to the ICU or having COVID-19 pneumonia. The decision to proceed with a cesarean section may be prompted by the need to improve ventilation.…”