ESAIC Academy

Summary: ESA Webinar series on COVID-19: 4th Episode: Obstetric Anaesthesiology Management
Dr. Hans-Christian Zaun, Ph.D.
Scientific Advisor, MULTILEARNING GROUP.

The fourth of a series of COVID-19 webinars is hosted by Prof. Dr. Ilona Bobek, of the Department of Anaesthesiology and Intensive Care Medicine, Budapest, Hungary, with the assistance of Scientific Faculty Leader, Prof. Dr. Marcelo Gama de Abreu of Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

Dr. Nuala Lucas from Northwick Park Hospital, Harrow, the United Kingdom, begins by discussing the epidemiology, clinical features and outcomes of COVID-19 in obstetrics. She gives a review of the case trajectory and comorbidities of  COVID-19 and continues with an overview of the predominant clinical features of COVID-19 associated with pregnancy. She points out that although initially, the evidence on vertical transmission from mother to baby was minimal, more recent reports have suggested the possibility. However, the outcomes have been very positive for neonates, and the impact on pregnancy has been low. She stresses the role of anesthesiologists in keeping the maternal units safe and prioritizing care during this pandemic.

Dr. Emilia Guasch from La Paz University Hospital, Madrid, Spain,  discusses analgesia used for labour in COVID-19 patients and reviews the literature on the subject. Dr. Guasch points out that early on, the literature gave little attention to the anesthetic and analgesic issues in obstetric care during the COVID-19 pandemic. More importantly, it is unknown what the future outcomes will be for COVID-19 patients, and long-term followups will be required. She discusses concerns regarding thrombotic and coagulopathy risk factors associated with COVID-19 patients and gives recommendations and guidelines to recognize severe patients. Furthermore, although they are many guidelines from different national medical societies, the one standard advice is that neuraxial labour analgesia as a safe technique to decreases the risks to patients and medical staff. Dr. Guasch continues by stressing the proper use of PPEs, particularly in donning and doffing as well as some practical advice, particularly on epidurals.

Dr. Carolyn Weiniger from Tel Aviv Sourasky Medical Center, Safed Area, Israel, discusses cesarian delivery and anesthesia management. Dr. Weiniger begins by stressing that COVID-19 is not an indicator for a cesarian section. She reviews the logistical challenges of managing a COVID-19 patient and emphasizes proper preparedness of the medical team, and recommends simulations, particularly the donning and doffing of personal protective equipment (PPEs). More importantly, Dr. Weiniger points out deciding for a cesarian section should be done early. She continues by reviewing the latest literature on anesthesia for a cesarian section and points out that the neuraxial anesthesia is the optimal strategy. She finishes with recommendations and guidelines on general anesthesia.

Dr. Lucas returns with a presentation on testing and proper PPE use. For testing, she stressed that adequate screening for all patients is of utmost importance. Regarding the appropriate use of PPE, Dr. Lucas emphasizes the importance of careful donning and doffing to prevent contamination and presents guidelines on their proper use. She continues by discussing some controversies that include Partners in the operating room as well as the issue of same-day discharge. Dr. Lucas stresses that although there is good evidence that day-one discharge is safe, the evidence of the safety of same-day discharge is limited and, therefore, does not recommends same-day discharge. She finishes by reviewing evidence that the use of non-steroidal anti-inflammatory drugs does not show any increased risk in COVID-19 patients in post-cesarian delivery. 

This webinar will enable caregivers of patients with COVID-19 to:

• ​Understand the challenges to manage obstetric patients with COVID-19, including identification, screening, tools for setting up a suitable environment in the labor ward, family member presence and postpartum recovery and considerations for safety of anaesthesiologists
• Learn decision paradigms for providing timely efficient labor analgesia to women with COVID-19, with specific consideration of the sick patient
• Discuss management of cesarean delivery including mode of anesthesia and minimizing need for emergency care through timely early decisions

https://www.rcog.org.uk/coronavirus-pregnancy
https://www.oaa-anaes.ac.uk/OAA_COVID19_Resources
https://icmanaesthesiacovid-19.org/management-of-pregnant-women-with-known-or-suspected-covid-19
https://www.wfsahq.org/resources/coronavirus
https://www.wfsahq.org/images/SOAP_COVID-19_Obstetric_Anesthesia_Care_031620-2_.pdf
https://www.wfsahq.org/images/coronavirus-covid-19-infection-in-pregnancy-v3-20-03-18.pdf
Lee JSE et al. Considerations and strategies in the organisation of obstetric anaesthesia care during the 2019 COVID-19 outbreak in Singapore. IJOA In press, journal pre-proof. Online 20 April 2020
 
Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis.
Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, Vecchiet J, Nappi L, Scambia G, Berghella V, D'Antonio F.
Am J Obstet Gynecol MFM. 2020 Mar 25:100107
 
COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals.
Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K, Ring L, Landau R, Purisch S, Friedman AM, Fuchs K, Sutton D, Andrikopoulou M, Rupley D, Sheen JJ, Aubey J, Zork N, Moroz L, Mourad M, Wapner R, Simpson LL, D'Alton ME, Goffman D.
Am J Obstet Gynecol MFM. 2020 Apr 9:100118. 
 
COVID19 during pregnancy: a systematic review of reported cases.
Della Gatta AN, Rizzo R, Pilu G, Simonazzi G.
Am J Obstet Gynecol. 2020 Apr 17.
 
Other publications in here: https://www.ncbi.nlm.nih.gov/pubmed/?term=covid-19+pregnancy