The impact of anesthesia choice on maternal and fetal outcomes in pregnant women with COVID-19 undergoing cesarean section

Abstract

Objective: Cesarean section (C/S) is frequently considered by the obstetricians for delivery in pregnant women with COVID-19. However, there is little data concerning the mode of anesthesia, whether general (G) or regional (R). This study aimed to compare general and regional anesthesia concerning the maternal and fetal outcomes in pregnant COVID-19 women undergoing C/S. Methods: Twenty-three consecutive pregnant women with COVID-19 admitted for delivery with C/S in our institute were enrolled in this retrospective analysis. All C/S procedures and anesthesia were performed by the same surgical team and the anesthesiologist. Subjects were divided into two groups according to the anesthesia procedure which was left to the anesthesiologist’s and obstetrician’s discretion. The difference in laboratory tests, length of hospital stay, maternal ICU admission, and 1st and 5th minute APGAR scores was the primary outcome measure of this study. Results: There were no significant difference s between the groups concerning fever, oxygen saturation, D-dimer, ferritin, C-reactive protein, leukocyte count, mean platelet volume and neutrophil to lymphocyte ratio. However, subjects receiving general anesthesia had higher procalcitonin at admission (1.2 ± 0.5, ng/mL vs. 0.6 ± 0.4, ng/mL, p=0.010). However, length of hospital stay was significantly longer in subjects receiving general anesthesia compared to those receiving regional anesthesia (18.5 ± 6.2 days vs. 12.6 ± 4.2 days, p=0.016). Moreover, 1st (6.1 ± 0.8 vs. 7.6 ± 0.5, p=0.011) and 5th minute (7.2 ± 1.4 vs. 8.9 ± 1.3, p=0.026) APGAR scores of the neonates born to mothers receiving general anesthesia were significantly lower compared to those born to mothers receiving regional anesthesia. Conclusions: Both regional and general anesthesia provide similar changes in surrogate markers of inflammation, and D-dimer. The length of the hospital stay was significantly higher in women undergoing C/S with general anesthesia compared to women receiving regional anesthesia during C/S. Moreover, the 1st and 5th minute APGAR scores were significantly lower in neonates born to mothers undergoing C/S with general anesthesia compared to women receiving regional anesthesia during C/S.

Keywords

• COVID-19
• pregnancy
• cesarean
• general anesthesia
• regional anesthesia

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