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Aim: Acute respiratory distress syndrome in pregnancy results in higher incidence of intraoperative and postoperative complications. In this case report, we discuss the perioperative management of a 31 year old woman, who developed acute respiratory distress syndrome (ARDS) due to Covid -19 infection and whose clinical status significantly improved after caesarean delivery.
Case presentation: A 31-year-old woman with a pregnancy at 34 weeks of gestation presented with ARDS associated with SARS-CoV-2 infection. An Xray revealed bilateral multifocal ground-glass opacities with partial consolidation, corresponding to COVID-19 pneumonia. Due to deterioration of her respiratory status and progressive hypoxemia (SpO2 less than 93%) she received 100% oxygen and caesarean section was performed with combined spinal and epidural anaesthesia at L3-L4 interspace. A low dose 1,6 ml solution of 0.75% ropivacaine with fentanyl (15 μg) was injected intrathecally, in order to avoid haemoynamic and respiratory compromise. In order to extend the sensory blockade until T4 level, the pregnant woman received an epidural top-up with 5 ml Lidocaine 2% and 4 ml ropivacaine 0,75%. An infant weighing 2.480 kg with Apgar scores of 9 at 1 and 5 minutes was delivered. The neonate was tested to be negative for COVID-19. After caesarean section, her respiratory condition quickly improved and she was discharged 12 days after.
Conclusion: The anaesthetic management of a cesarean section in a pregnant woman who developed ARDS is a particular challenge. The timing of delivery should be determined by considering the progression of ARDS and age of gestation. Titration of combined spinal epidural anaesthesia may reduce the risk of viral spread, avoid airway manipulation and minimize the risk of pulmonary complications. Moreover, it offers the benefit of avoiding intraoperative hypotension.
1. William T Schnettler , Yousef Al Ahwel , Anju Suhag . Severe acute respiratory distress syndrome in coronavirus disease 2019-infected pregnancy: obstetric and intensive care considerations. Am J Obstet Gynecol. 2020 ;2:100120.
2. Melissa E Bauer, Kyra Bernstein, Emily Dinges et al, Obstetric Anesthesia During the COVID-19 Pandemic. Anesth Analg, 2020;131:7-15
3. Mls Takemoto, M O Menezes, C B Andreucci et al, Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis. BJOG, 2020;127:1618-1626.
Giolanda Varvarousi1, Asimina Panagopoulou1, Athanasia Saiti1, Dimitrios Valsamidis1
1 Department of Anaesthesiology, Obstetric Department, Alexandra Hospital, Athens, Greece

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