Perioperative Setting in Emergency Caesarean Section for a Pregnant Woman With Coronavirus Disease 2019: A First Case Report

Abstract

Emergency caesarean section (ECS), also referred to as a “category 1 caesarean section,” is less commonly performed but may become unexpectedly necessary in critical obstetric emergencies. During a trial of labour in high-risk pregnancies, the potential need for ECS should always be anticipated. Even during the coronavirus disease 2019 (COVID-19) pandemic, trials of labour in pregnant women with COVID-19 have remained common. While preoperative management protocols for ECS are essential as contingency plans, well-defined strategies for the safe and timely preparation of ECS in pregnant women with COVID-19 remain lacking. We present the case of a 35-year-old primiparous woman at term gestation who was diagnosed with mild COVID-19 during induction of labour. During cervical ripening, severe foetal distress was detected, prompting an ECS due to suspected abruptio placentae and/or uterine rupture. Institutional preoperative management strategies for emergency surgery in patients with COVID-19, including infection control measures, prepackaged surgical supplies, simulation training, and established ECS protocols, enabled the medical team to promptly arrange the procedure. The infant was delivered in good health within 30 min of the decision to proceed with ECS and tested negative for infection. By integrating obstetric ECS protocols with preoperative management strategies for emergency surgery in patients with COVID-19, such cases can be successfully managed. This case report describes the preoperative preparation for ECS in a pregnant woman with COVID-19, despite limited clinical guidance and stringent infection control requirements. Our experience may contribute to the development of rapid and safe ECS preparation protocols for pregnant patients requiring isolation during future infectious disease emergencies.