Characteristics and outcomes of pregnant women with confirmed COVID-19 infection posted for cesarean section. A retrospective, Cohort study

Background and Aim of the Study: Clinical and epidemiological features of COVID-19 infection have been widely reported. However, clinical studies on maternal and neonatal outcomes of pregnant women with COVID-19 infection remain sparse. The aim of this study was to describe the characteristics and outcome of pregnant women with confirmed COVID-19 infection posted for cesarean section. Objectives: To describe demographic and clinical characteristics of pregnant women with confirmed COVID-19 infection. To analyze the data regarding indications for cesarean section, type of anesthesia administered, and incidence of perioperative complications. To document and analyze the data regarding maternal and neonatal outcomes. Method: Study Design: A cohort retrospective study was conducted in the Department of Anesthesiology, Institute of pregnant woman (IPW), Sri Venkateswara Medical College (SVMC), Tirupati. Retrospective review of medical records of pregnant women with confirmed COVID-19 infection posted for cesarean section admitted in IPW/SVMC, tertiary care teaching hospital in Tirupati during May 2020 to January 2021 (9 months) was done, and the data regarding maternal demographic and clinical characteristics, type of anesthesia administered, the incidence of perioperative complications, and outcomes were collected and analyzed. Results: A total of 197 patients had undergone cesarean section in our IPW/SVMC, tertiary care Teaching Hospital, Tirupati, AP, INDIA. Most of the women werere aged in the range of 20 to 30 years – 138 cases (70%). A total of 104 pregnant women (52%) were without co-morbidities. A total of 163 pregnant women (83%) were asymptomatic on admission. Most of the cesarean births occurred for indications other than maternal compromise due to COVID-19 infection. A total of 186 women (94%) gave birth at term and 5% gave birth at preterm. Outcomes of pregnant women with confirmed COVID-19 infection posted for cesarean section are as follows: the number of live births (including twins) was 197 (99%), 1 case of IUD, and 1 stillbirth occurred (1%). Out of 197 live births, 180 neonates (91%) were born with a birth weight of more than 2.5 kg, and 8% of them were low birth weight (< 2.5 kg) babies. Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at 1 min and 5 min after birth (mean ± SD) were 9 ± 0. 5 and 10 ± 0.0, respectively. The type of anesthesia administered was spinal anesthesia in all the cases (100%), and there was no significant incidence of perioperative complications when compared to the general population. Most of the pregnant women were discharged well to home (n = 196), one patient needed COVID- ICU admission, and one patient died due to acute respiratory failure. Most of the neonates were discharged well to home. Conclusion: Most of the pregnant women with confirmed COVID-19 infection posted for cesarean section do not have severe illness, and there is no significant maternal morbidity and mortality related to SARS-CoV-2 (COVID-19) infection. Spinal anesthesia is the safest anesthesia procedure in pregnant women with confirmed COVID-19 infection posted for caesarean section.