key: cord-0891890-qrpdpu75
authors: Elkhyat, M.; Eltinay, F.; Elwir, B.; Botros, S.
title: P.148 Pregnancy and COVID 19: a case series at Royal Derby Hospital
date: 2022-05-31
journal: International Journal of Obstetric Anesthesia
DOI: 10.1016/j.ijoa.2022.103444
sha: 9d67afe62b610db64826615c58cb7eca82a0741b
doc_id: 891890
cord_uid: qrpdpu75

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Introduction: Cardiac disease is the leading cause of maternal mortality in the UK. Ischaemic heart disease (IHD) contributes to 24% of cardiac deaths [1] . Methods: We retrospectively reviewed records of 13 parturients with a diagnosis of IHD at St Mary's Hospital between 1 April 2015 and 1 April 2021. Results: In the study period our centre had 58,876 deliveries, giving an incidence of IHD of 1 per 4528 maternities. Eleven (84.6%) patients had a pre-existing diagnosis and two (15.4%) were diagnosed in this pregnancy. Most patients (92.3%) were multiparous. Mean age was 31.8 (±6.9) years and booking body-mass index was 26.53 (±5.29) kg/m 2 . Predisposing factors for IHD were: family history (38.4%), smoking (23.1%), hypertension (23.1%), and obesity (23.1%). Causes of IHD were: atherosclerosis (53.8%), coronary artery dissection (15.4%), congenital heart disease (7.7%), coronary artery spasm (7.7%), coronary artery aneurysm (7.7%) and idiopathic (7.7%). A previous ST-elevation myocardial infarction (STEMI) was reported in 61.5% of patients, and non-STEMI in 21.4%. Invasive management of IHD occurred in 73% of patients, with 58% having a percutaneous coronary angioplasty and 15% a coronary artery bypass graft. The majority of patients (77%) had a caesarean delivery (CD). Neuraxial anaesthesia was reported in 90% of these cases. A vaginal birth occurred in 23% of patients with 66.7% utilising epidural analgesia and 33.3% using remifentanil patientcontrolled analgesia. Post-partum haemorrhage (>500 mL) was recorded in 15.4% of all patients. There was no maternal mortality. Mean maternal length of hospital stay was 4.7 (±2.5) days. Mean gestation at delivery was 36.2 (±2.3) weeks with 46% of deliveries being <37 weeks. All 10-min Apgar scores were ≥9. Mean birthweight was 2318 g (±476) with 65% being of low birth weight (<2700 g). Neonatal intensive care admission rate was 23%. Discussion: Our data on parturients with IHD show a high CD, preterm birth rate, and low birthweight consistent with existing literature [2] . Factors contributing to the high CD rate are previous CD (65%) and joint, maternal decision-making with the pregnancy heart team. Fetal outcomes were possibly influenced by beta blocker usage, prematurity, and smoking. Serial inputs from a dedicated pregnancy heart team, and increased postpartum surveillance is mandatory and integral to limit maternal-fetal morbidity and improve outcomes in this cohort. 

Introduction: Recent data show pregnancy to be a risk factor for more severe COVID-19, anatomic changes occur in pregnancy which may affect the management of the patient with COVID-19. The upper airway becomes oedematous and friable in pregnancy making intubation more difficult [1] .Pregnancy is a pro-thrombotic state, as is COVID-19 [2] . An incidence of preeclampsia has been described in women with COVID, but some features of COVID-19 infection may mimic preeclampsia. Elevated liver enzymes, thrombocytopenia, and a prolonged aPTT can be seen with both diseases. Methods: A retrospective audit of pregnant females with COVID-19 required ICU admission from March 2020-January 2022 at Royal Derby Hospital. Results from cases were analysed for need for intubation, mode of delivery, medical management as dexamethasone and tocilizumab and past medical history. Results: Seven cases needed ICU care, one case was morbidly obese, all cases received dexamethasone, none required ECMO, all were delivered by caesarean section and there was one neonatal death. [1] .

Results: There were 68 COVID-19 positive patients in hospital over the study period. 72% patients had BMI <30. Significantly more (54%) positive patients were of Asian or Afro-Caribbean origin (P = 0.006). 85% patients of patients were positive antenatally with a mean gestation of 33 weeks (SD 4.79). Of the 15% postnatal infections, most occurred within first five days of delivery, indicating possible crossinfection. With regards to treatment, 88.2%, were asymptomatic and did not require oxygen support, 7.4% required supplemental O2, 2.9% required NIV, and 1.5% required invasive management and transfer for ECMO to a higher centre. Mortality in our study was 2.9% for mothers, both patients were of BAME origin. However, neonatal outcome was good with no associated mortality. 47% of the patients were delivered by CS of whom 20% needed their CS expedited due to COVID-19 having a mean gestation of 29 weeks (SD 4.7). Among the patients who had CS, 93% had a regional anaesthetic and 7% had a GA. Discussion: BAME was a significant risk factor for pregnant COVID-19 positive patients to be hospitalised. BAME category patients were more symptomatic and required prolonged hospital stay [1] . BMI>30 was not found to be a significant risk factor. COVID-19 caused a high incidences of CTG abnormalities and hence lead to a higher incidence of CS during this period. Regional anaesthesia was performed safely in these patients. Cross infections in maternity unit paved the establishment of Closed Monitoring Unit (CMU) at our centre. Due to the ongoing pandemic, further study is needed to see impact of vaccination on maternity.

P.150 Anaesthetic care of women with obesity in pregnancy E. Foley, S. Cope

Introduction: Obesity in pregnancy is associated with an increased risk of anaesthetic complications, such as failure of airway management, intravenous access and neuraxial blockade [1] . Therefore, the Royal College of Anaesthetists defined a set of standards for the care of obese pregnant women. Our aim was to measure current practice against these standards; 100% of women with a booking BMI (body mass index) of 40 kg/m 2 or greater to have an antenatal consultant anaesthetic review and 100% of these patients to be reviewed by the duty anaesthetist on arrival to delivery suite. Methods: A retrospective audit of 50 sets of patient notes with a BMI 40 kg/m 2 or greater at booking during the period of January-June 2020 at Sunderland Royal Hospital. It was identified whether the patient had been referred to anaesthetics, the outcome of this referral (either no action required or an appointment in the high-risk clinic) and whether an assessment was made by anaesthetics on the delivery suite. Ethics approval was not required for this audit as advised by the trust's clinical effectiveness department.

Results: A total of 54% of eligible patients were referred to anaesthetics; 100% of these patients were screened by an obstetric anaesthetist with 41% of those patients being seen in the high-risk clinic. Only 6% of all patients were assessed by a member of the anaesthetic team on arrival to delivery suite with a plan documented in the notes. Discussion: There must be a more robust system for the referral of high BMI patients to anaesthetics both antenatally and on delivery suite in order to plan early for the management of predicted difficult airway, intravenous access and neuraxial blockade as well as the early involvement of senior anaesthetic help. We have now written a guideline to ensure the above standards are met in future and this will be re-audited after the guideline is implemented.

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Saving Lives, Improving Mothers' Care -Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity

Acute coronary syndrome and ischemic heart disease in pregnancy: data from the EURObservational Research Programme-European Society of Cardiology Registry of Pregnancy and Cardiac Disease

COVID-19) infection in pregnancy -guide for healthcare professionals v14

The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study