Published: 2021-11-26

Anaesthetic management in COVID-19 parturients scheduled for caesarean delivery - a comparison with non-COVID-19 parturients

Ranju Singh, Pooja Singh, Eashwar Neelakandan, Maitree Pandey, Manju Puri, Sushma Nangia


Background: Data regarding outcomes after anaesthesia in COVID-19 parturients is scanty. There is hardly any information about the length of hospital stay in COVID-19 parturients who undergo caesarean delivery (CD) as compared to non-COVID-19 parturients.

Methods: An observational study of COVID-19 parturients undergoing CD was conducted. Age and CD indication matched non COVID-19 parturients were taken as controls. The length of hospital stay along with maternal and neonatal outcomes were studied.

Results: A total of 45 COVID-19 parturients and an equal number of non-COVID-19 parturients were studied. The length of hospital stay was significantly longer in COVID-19 parturients as compared to non-COVID-19 parturients (4.3±1.6 days versus 3.3±0.6 days, p=0.02). One COVID-19 parturient developed severe disease and expired. Apart from this case, the maternal and neonatal outcomes were comparable between the two groups. Mild thrombocytopenia was seen in COVID-19 parturients. One neonate had a positive reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on first day of life.

Conclusions: COVID-19 parturients who undergo CD have a longer length of hospital stay than non-COVID-19 parturients. Severe disease is likely to be associated with longer length of hospital stay. Intraoperative hypotension, maternal and neonatal outcome is not significantly different between COVID-19 and non COVID-19 although mild thrombocytopenia is seen in COVID-19 parturients. While vertical transmission of SARS-CoV-2 may be possible, more data is needed regarding vertical transmission is needed.


Caesarean section, COVID-19, Intraoperative hypotension, Length of stay, Spinal anaesthesia, Vertical transmission

Full Text:



World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). WHO-China Jt Mission Coronavirus Dis 2019 2020;1:40.

Wong SF, Chow KM, Leung TN. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191:292-7.

Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27:791-802.

Chen R, Zhang Y, Huang L, Heng CB, Yuan XZ, Tao MQ. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth. 2020;67:655-63.

Ashokka B, Loh M-H, Tan CH. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol. 2020;223:66-74.

Chhabra A, Rao T, Kumar M, Singh Y, Subramaniam R. Anaesthetic management of a COVID-19 parturient for caesarean section - Case report and lessons learnt. Indian J Anaesth. 2020;64:141.

Xu S, Shao F, Bao B, Ma X, Xu Z, You J, et al. Clinical Manifestation and Neonatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. Open Forum Infect Dis. 2020;7(7):ofaa283.

Zhong Q, Liu YY, Luo Q, Zou YF, Jiang HX, Li H, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study. Br J Anaesth. 2020;124(6):670-5.

Barbero P, Mugüerza L, Herraiz I, García Burguillo A, San Juan R, Forcén L, et al. SARS-CoV-2 in pregnancy: characteristics and outcomes of hospitalized and non-hospitalized women due to COVID-19. J Matern Fetal Neonatal Med. 2020:1-7.

Le Gouez A, Vivanti AJ, Benhamou D, Desconclois C, Mercier FJ. Thrombocytopenia in pregnant patients with mild COVID-19. Int J Obstet Anesth. 2020;44:13-5.

Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, e al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(5):559-64.

Šklebar I, Bujas T, Habek D. Spinal anaesthesia-induced hypotension in obstetrics: prevention and therapy. Acta Clin Croat 2019;58(1):90-5.

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:8.

Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9:51-60.

Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Cao JD, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11:3572.

Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, Zhou W. Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr. 2020;174(7):722-5.

Centeno Tablante E, Medina Rivera M, Finkelstein JL, Finkelstein JL, Rayco-Solon P, Garcia-Casal MN, et al. Transmission of SARS CoV 2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci. 2021;1484(1):32-54.

Pereira A, Cruz-Melguizo S, Adrien M. Breastfeeding mothers with COVID-19 infection: a case series. Int Breastfeed J. 2020;15:69.