Perioperative Outcome of COVID-19-Positive Parturient Posted for Cesarean Section—Our Experience in a Tertiary Care Hospital in Northern India

Abstract

Abstract Introduction  There is insufficient data regarding the severity of coronavirus disease 2019 (COVID-19) infections in pregnant women. This study assessed the outcome of COVID-19-positive parturient after cesarean section, correlation of maternal mortality with COVID-19 severity, association of comorbid parturients with severe COVID-19, and number of patients requiring general anesthesia. Materials and Methods  This single-center, retrospective observational study was performed on reverse transcriptase polymerase chain reaction confirmed COVID-19-positive 89 parturients posted for elective or emergency cesarean section. Data was collected from medical records of our hospital regarding COVID-19 severity, maternal mortality, need for admission in intensive care unit, gestational age, maternal comorbidities, indication for cesarean section, type of anesthesia, duration of surgery, neonatal birth weight, neonatal mortality, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and neonatal intensive care unit (NICU) admission. Assessment of maternal outcome was the primary objective. Secondary objectives of this study were to correlate maternal outcome with COVID-19 severity, to find association of comorbid parturients with severe COVID-19 and to estimate number of patients requiring general anesthesia. Results  Out of 89 patients, 79 patients had mild COVID-19 disease were on room air and 6 patients required preoperative oxygen supplementation, and 4 patients diagnosed to have severe COVID-19 pneumonia were on mechanical ventilator preoperatively. Four cases were operated under general anesthesia and remaining 85 parturients were operated under regional anesthesia. Out of four parturients with severe COVID-19 pneumonia, three patients did not survive in postoperative period due to refractory hypoxemia. In eight patients, spinal anesthesia was repeated due to inadequate effect. Fourteen neonates (16.09%) required NICU stay after cesarean delivery. Conclusions  Parturients with severe COVID-19 disease had higher mortality. No statistically significant association was found between number of comorbidities and severity of COVID-19. The results of this study will guide us regarding further management and prognostication of COVID-19-positive parturients posted for cesarean section.