Omer Ibrahim Abdalla Eynas, Nahid Seema, Shastham Valappil Sikha, Gudavalli Srinivas, Sellami Soumaya, Korichi Noureddine, Ahmad Shamsa, Vicente Canizares Cespedes Victor, Gopalakrishnan Santhosh
Anesthesia Department, Hamad Medical Corporation, Doha, Qatar E-mail:
Qatar Med J. 2022 Jul 11;2022(3):30. doi: 10.5339/qmj.2022.30. eCollection 2022.
Pregnancy affects a woman's susceptibility to and severity of certain infectious diseases. Central neuraxial block for analgesia during labor is superior to nonneuraxial methods in efficacy, safety, and maternal satisfaction. Although Coronavirus disease (COVID-19) can be vertically transmitted from mother to fetus, little is known about the effects of COVID-19 on pregnant women or about anesthesia management and the risk of adverse effects related to neuraxial techniques in women with untreated COVID-19 during gestation.
This investigation assesses the effects of neuraxial analgesia during labor of COVID-19-positive parturients on their hemodynamic stability.
The study was conducted on 64 patients and involved 32 parturients positive for SARS-CoV-2 by polymerase chain reaction (PCR) and a similar number of control "negative" patients. The affected group had an uneventful course during gestation. Seven were positive for ground-glass opacities on chest X-rays, and none underwent computed tomography (CT) scans. Two neonates were PCR-positive for SARS-CoV-2, and all 32 neonates were released from the hospital. No clinical differences were observed between the neonates in the COVID-19 and control groups. Although parturients in both groups were hemodynamically stable, hemodynamic stability was subnormal in the COVID-19 group regarding blood pressure, oxygen saturation, heart rate, and body temperature. None of the women in either group required a vasopressor or oxygen supplementation during delivery. No other clinical differences were observed between the COVID-19 and control groups.
This is the first case-controlled study testing the anesthetic implications of neuraxial labor analgesia in pregnant, COVID-19-positive women. Although management of neuraxial labor analgesia did not differ in pregnant women positive and negative for COVID-19, their hemodynamic characteristics differed significantly. Therefore, care is required to prevent adverse outcomes in pregnant women positive for COVID-19.
妊娠会影响女性对某些传染病的易感性及疾病严重程度。分娩时用于镇痛的椎管内阻滞在疗效、安全性及产妇满意度方面优于非椎管内方法。尽管冠状病毒病（COVID-19）可通过母婴垂直传播，但关于COVID-19对孕妇的影响，以及妊娠期间未治疗的COVID-19女性患者的麻醉管理和与椎管内技术相关的不良反应风险，人们所知甚少。
本研究评估COVID-19阳性产妇分娩时椎管内镇痛对其血流动力学稳定性的影响。
该研究纳入64例患者，其中32例经聚合酶链反应（PCR）检测为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）阳性的产妇，以及数量相近的对照“阴性”患者。感染组在妊娠期过程顺利。7例胸部X线显示磨玻璃样阴影，均未进行计算机断层扫描（CT）。2例新生儿PCR检测为SARS-CoV-2阳性，所有32例新生儿均已出院。COVID-19组和对照组新生儿未观察到临床差异。尽管两组产妇血流动力学均稳定，但COVID-19组在血压、血氧饱和度、心率和体温方面的血流动力学稳定性低于正常水平。两组均无女性在分娩期间需要血管升压药或吸氧。COVID-19组和对照组未观察到其他临床差异。
这是第一项测试椎管内分娩镇痛对COVID-19阳性孕妇麻醉影响的病例对照研究。尽管COVID-19阳性和阴性孕妇的椎管内分娩镇痛管理无差异，但她们的血流动力学特征存在显著差异。因此，需要谨慎预防COVID-19阳性孕妇出现不良结局。
