Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

L E G Scoon; K J Gray; G Zhou; R Y Cohen; W Armero; Y K Chen; A M Ray; K Diouf; I T Goldfarb; A A Boatin; V P Kovacheva

doi:10.1016/j.ijoa.2022.103624

Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

Int J Obstet Anesth. 2023 Feb:53:103624. doi: 10.1016/j.ijoa.2022.103624. Epub 2022 Dec 28.

Authors

L E G Scoon¹, K J Gray², G Zhou³, R Y Cohen⁴, W Armero⁵, Y K Chen⁴, A M Ray⁴, K Diouf⁶, I T Goldfarb⁷, A A Boatin⁷, V P Kovacheva⁸

Affiliations

¹ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Georgetown University School of Medicine, Washington, DC, USA.
² Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁶ Division of General OBGYN Specialists, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, USA, Harvard Medical School, Boston, MA, USA.
⁸ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: vkovacheva@bwh.harvard.edu.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design.

Methods: We searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery.

Results: We identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation -0.55, 95% CI -0.81 to -0.09).

Conclusions: Patients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.

Keywords: Anesthesia, spinal; Blood pressure; COVID-19; Hypotension, pregnancy; SARS-CoV-2.

MeSH terms

Anesthesia, Spinal* / adverse effects
COVID-19*
Case-Control Studies
Female
Hemodynamics
Humans
Hypotension* / etiology
Infant, Newborn
Pregnancy
Pregnancy Complications, Infectious* / diagnosis
Retrospective Studies
SARS-CoV-2

Grants and funding

K08 HL146963/HL/NHLBI NIH HHS/United States