Summary of considerations for obstetric anaesthesia and COVID19

·       There is no evidence of vertical transmission of coronavirus, although a Chinese case series of 9 pregnant women suggested there may be an increased risk of foetal distress in mothers with COVID-19.

·       It is likely anaesthetists will need to care for women urgently, prior to confirmation of their COVID-19 status.

·       There is no contra-indication to neuraxial anaesthesia, which avoids the aerosol- generating risks associated with intubation. The presence of coagulopathy should be considered in unwell COVID19-suspected or COVID19-positive women prior to neuraxial anaesthesia or analgesia. 

·       The Royal College of Obstetricians and Gynaecologists (RCOG) advise that entonox is considered safe if used with a viral filter to reduce contamination and aerosolisation (<0.05 microns) however we consider the use of Entonox in labour may contribute to increased aerosol and droplet spread.

·       Skin to skin contact and management of the baby should follow local advice. Anaesthetists should communicate with paediatric/neonatology colleagues about physical arrangements in the operating theatre should separation of mother and baby be required.

·       In the case of Category 1 caesarean section, RCOG notes that donning PPE is essential, time consuming and may impact on the decision to delivery interval. Communication between anaesthetists and their obstetric colleagues is critical so women and their families are aware of this possible delay. 

·       In the case of Category 1 caesarean section, the benefits of neuraxial anaesthesia in the COVID19-suspected or COVID19-positive woman are even greater, by avoiding aerosol-generating procedures.  Institutions who regularly use general anaesthesia for these cases may need to review their practice in conjunction with obstetric colleagues.

·       It is unknown if the treatment of postpartum pain with NSAIDs will worsen the trajectory of COVID19-positive women. NSAIDs can likely continue to be used safely in asymptomatic patients.

This information was compiled from the following resources which are being updated continuously:

https://soap.org/education/provider-education/expert-summaries/interim-considerations-for-obstetric-anesthesia-care-related-to-covid19/

 https://www.rcog.org.uk/coronavirus-pregnancy