Perioperative Implications of Obstetric Anaesthesia Care during COVID-19 Crisis

Abstract

This article reviews the WHO and CDC guidelines related to obstetrics keeping in view the current Covid-19 pandemic. We are currently facing an unprecedented healthcare crisis caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infection is spread by human-to-human transmission through droplet and direct contact, causing mild symptoms in the majority of cases, but critical illness, bilateral viral pneumonia, and acute respiratory distress syndrome (ARDS) in a minority. We suggest how personal protective equipment’s (PPE’s) and specific infection control policies related to the risk of viral transmission to the anaesthetists, intensivists and other healthcare workers can be minimised particularly in obstetric patients. Although pregnancy doesn’t appear to exhibit higher susceptibility to COVID-19 than the general population but implementing strict infection control in the maternity department presents unique challenges. Particularly it necessitates decreasing the risk of postnatal transmission from mother to neonate and methods to accommodate emergency patients to labour ward and emergency care with a high patient turnover. Performing routine and emergency procedures for obstetric patients, such as neuraxial anaesthesia, is made more technically difficult and time consuming by wearing a PPE. These new challenges have anaesthetic implications and mandate a change in approach for team working, protocols for perioperative anaesthesia care and infection prevention policies. With limited evidence as of now but antenatal vertical transmission appears to be rare.Placental samples, amniotic fluid, cord blood, neonatal throat swabs and breast milk samples from COVID-19 infected mothers have all tested negative in various case series. There is currently no evidence concerning transmission through genital fluids. Pregnant patients presenting to the emergency room and labour ward should be risk stratified and then screened for covid-19 irrespective of being symptomatic or not before admission and subsequent care provided taking all the precautions. Aerosol generation during labour, particularly when coupled with symptoms secondary to COVID-19 lung sequelae, may increase airborne transmission. For these reasons, surgical facemasks should be worn by the parturient Proper donning and doffing of PPE is paramount for decreasing the risk of transmission of infection for labour epidural, OT’s and obstetric ICU’s and needs creation of space within the older system and newer guidelines and protocols to be implemented in letter and spirit.