key: cord-1055711-cefxhcs6
authors: McCallum, A.R.; Shaw, M.; Litchfield, K.; Broom, M.A.; Kearns, R.J.
title: P.21 COVID-19 and category 1 caesarean sections: effect of anaesthetic practice changes on maternal and neonatal outcomes
date: 2021-06-09
journal: Int J Obstet Anesth
DOI: 10.1016/j.ijoa.2021.103019
sha: ab77e72192d8d307110aa6c9fc7ba2a1394c85fb
doc_id: 1055711
cord_uid: cefxhcs6

nan

Introduction: National obstetric guidelines produced during the COVID-19 pandemic recommend avoiding general anaesthesia unless absolutely necessary. 1 Within our tertiary referral hospital, the pandemic also enforced staffing and organisational changes (including 24h consultant-delivered care and additional overnight staffing). We aimed to investigated the association of these practice changes on anaesthetic technique for category-1 caesarean section (CS) and on obstetric and neonatal outcomes.

Methods: Caldicott Guardian approval was obtained and requirement for formal ethical review waived by the local research ethics service. Data were collected on all category-1 CS during the initial 2 month COVID-19 period (27 March -27 May 2020), versus the preceding 13-months (1 March 2019 -26 March 2020). Data were summarised using median [IQR] and count (%) with differences between groups tested using Pearson exact and Wilcoxon rank sum testing. Statistics were performed using R version 4.0.3.

Results: In the control group 122 patients delivered by category-1 CS, with 18 patients in the COVID-19 cohort. There were 3 cases with missing data in the control cohort (n = 119). General anaesthesia was utilised in 48/119 cases (40.3%) in controls and 0/18 patients in the COVID-19 cohort. Spinal anaesthesia rates increased from 51/119 (42.9%) to 16/18 patients (88.9%) in the COVID-19 group. Decisionto-delivery intervals did not differ between the 2019 and 2020 cohorts and no differences in neonatal outcomes were observed between groups.

Discussion: The COVID-19 pandemic was associated with a marked reduction in general anaesthesia, and a doubling in spinal anaesthesia. Decision-to-delivery intervals, and neonatal outcomes were not found to differ. Staffing and organizational reconfiguration during this time supported these practice changes. Whether these findings are reproducible longer-term requires further investigation. Introduction: For elective (category 4) caesarean section, regional anaesthesia is generally considered the superior method and the Royal College of Anaesthetists suggest an audit standard of >95% of such deliveries being carried out under a regional technique. 1 Within our large tertiary obstetric unit, we aimed to characterise the reasons for undertaking planned elective general anaesthesia for caesarean section.

Methods: All patients undergoing elective caesarean section under general anaesthesia between January 2018 and December 2019 were retrospectively identified through interrogation of our local theatre management system. The electronic records of these patients were then scrutinised for demographic information and to determine the underlying reason for elective general anaesthesia.

Results: A total of 1956 elective caesarean sections were carried out over the 2-year period; in thirty three of these (1.7%) general anaesthesia was pre-planned anaesthetic technique. The top three reasons cited for general anaesthesia are as shown in the Table. Of the 10 patients who requested general anaesthesia, 30% did so because of needle phobia, 30% due to a previous poor experience of regional anaesthesia and 20% due to a previous positive experience of obstetric general anaesthesia.

Discussion: We demonstrate low rates of general anaesthesia for elective caesarean section, compared to published data. 2 Of those who do undergo elective general anaesthesia, maternal request is the most common indication, with the majority refusing regional anaesthesia either due to a previous poor experience or anxieties regarding the technique (i.e. needle phobia). Further work may include interventions to address these barriers to regional anaesthesia and increasing our understanding of the subject through a larger cohort of patients.

Management of pregnant women with known or suspected COVID-19

Raising the Standards: RCoA Quality Improvement Compendium

Choice of anesthesia for cesarean delivery: an analysis of the National Anesthesia Clinical Outcomes Registry