key: cord-0868638-ivfwtd2t
authors: Ramachandran, V.; Bouras, L.; Akhtar, R.
title: P.20 “Out of severe COVID in peripartum women”
date: 2022-05-31
journal: International Journal of Obstetric Anesthesia
DOI: 10.1016/j.ijoa.2022.103316
sha: d299544344b1a0e74e6cef5c14356f914f8c2892
doc_id: 868638
cord_uid: ivfwtd2t

nan

P.20 "Out of severe COVID in peripartum women" V. Ramachandran, L. Bouras, R. Akhtar University Hospitals of North Midlands, UK Introduction: Although pregnant women appear to have a similar risk of contracting SARS CoV2, morbidity for obstetric patients is increased for ethnic minorities, maternal age >35 years, associated comorbidities and lower socio-economic groups [1] . SARS-CoV2 infection leads to an increased risk of preterm delivery, caesarean section (CS), stillbirth, and possible fetal growth restriction. Guidance recommends senior multidisciplinary involvement in decision making on how and when to deliver. A retrospective observational survey was performed, looking at maternal and fetal outcomes in women needing ICU admission with SARS CoV2 from March 2020 to November 2021 in our hospital. Methods: Following the registration of the audit with Hospital Trust, electronic notes were retrospectively reviewed. Data collected were: demographics, mode of delivery, platelet count, type of anaesthetic, days of ventilation and outcome. Results: During the study period 13,223 women were admitted to hospital of whom 201 tested positive for SARS CoV2; 10 were admitted to ICU. Three patients were from ethnic minorities and all were unvaccinated. Only one parturient who was ventilated before delivery had a stillbirth. Of the nine who delivered in our hospital, seven were admitted to ICU within 48 h of CS, one at 10 days, and one at 46 days postpartum. The decision to deliver was due to increasing respiratory distress in all patients except one who had resistant SVT. All patients required invasive ventilatory support in ICU, five required proning, two needed tracheostomy and two died. Discussion: There was a significant increase in SARS CoV2 severity after unlocking the "second wave" (1/8/2020) vs. none in the first. SARS CoV2 infection was seen in 1.5% of all maternity admissions and mortality was 0.99%. Worsening maternal condition was the deciding feature for GA, not thrombocytopenia [2] . Two women who were not delivered early had significant events; one had a maternal peri-arrest at delivery, the other had a stillbirth. Their deteriorating condition required prompt delivery for maternal and fetal optimisation prior to ICU admission. Methods: A MDT of anaesthetists, midwives and obstetricians, devised a 6-point checklist to address critical safety steps. This was ratified at the local perinatal safety forum and instructions provided to the MDT. Checks addressed a recent 'fresh eyes' review, clinical appropriateness of epidural insertion, continuous fetal monitoring and MDT communication. A one-month pilot was undertaken, during which the checklist was read aloud at the bed space before epidural insertion and actioned upon if necessary. All members of the MDT and the parturient (± birth partner) were asked to anonymously complete a feedback questionnaire. Results: 68 labour epidurals were sited over the pilot period. Feedback was captured from 56 MDT members with equal spread of anaesthetists (34%), midwives (32%) and operating department practitioners (34%). 49 (88%) of responses felt the checklist encouraged MDT communication and 47 (84%) felt that the checklist increased parturient and fetal safety. Free-text feedback identified that staff felt the checklist helped them to voice concerns. Feedback was captured from 20 parturients/birth partners. 19 found the checklist reassuring (95%). No parturients reported increased anxiety. Discussion: This MDT checklist has been successfully piloted and has achieved its aims. Whilst it is not possible to directly measure the checklist's impact on morbidity or mortality, it has the potential to improve maternal and fetal outcomes. Following MDT discussion and review, our institution has decided to embed this checklist into routine practice for the benefit of staff, parturients and babies. 

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