Parturients with COVID-19 undergoing anaesthesia or analgesia for labor, delivery or cesarean section: a retrospective observational study

Background: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported for the first time in Wuhan (China) and declared a pandemic in March 2020. To date there is limited data about the clinical features, anaesthetic management and outcomes of infected pregnant patients. The aim of this study was to characterize the clinical experience and safety of different anaesthetic techniques in infected pregnant women undergoing anaesthesia or analgesia for labor, delivery or cesarean section. Methods: A retrospective study including all admitted parturients with positive test for SARS-CoV-2 was conducted at University Hospital Center of Sao Joao. Demographic and epidemiological context, laboratorial tests and radiological imaging at admission were collected. Analgesic/anaesthetic procedures, surgery-related data and maternal and neonatal outcomes were analysed. Results: Fifteen pregnant patients infected with  SARS-CoV-2 were included. Symptoms and clinical characteristics were similar to those previously reported in non-pregnant adult patients. Vaginal delivery and neuraxial analgesia/anaesthesia were conducted in most of the cases, in contrast with other reports. Of the patients submitted to epidural analgesia, most of them remained under patient controlled epidural analgesia until birth. Only one case underwent general anaesthesia with tracheal intubation. All newborns were negative for SARS-CoV-2. There were no maternal or neonatal complications or critical events.  Conclusions: In this study, regional anaesthesia techniques for labor analgesia and/or anaesthesia were the first line option for management of SARS-CoV-2 positive pregnant. Safety and efficacy of this anaesthetic procedures were verified without maternal or neonatal complications.