COVID in obstetrics: labor analgesia and cesarean section.

Emilia Guasch, Nicolas Brogly, Fernando Gilsanz

Current opinion in anaesthesiology 2021 Feb 01

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This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers. COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized. Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Citation

Emilia Guasch, Nicolas Brogly, Fernando Gilsanz. COVID in obstetrics: labor analgesia and cesarean section. Current opinion in anaesthesiology. 2021 Feb 01;34(1):62-68