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Table of Contents
Year : 2020  |  Volume : 4  |  Issue : 6  |  Page : 36-38

Postoperative management of obstetrics and gynecology patients in the coronavirus disease 2019 era

Department of Obstetric and Gynaecology, Faculty of Medicine, Udayana University, Bali, Indonesia

Date of Submission20-Jun-2020
Date of Decision12-Oct-2020
Date of Acceptance10-Aug-2020
Date of Web Publication05-Oct-2020

Correspondence Address:
Dr. I Gde Sastra Winata
Department of Obstetric and Gynaecology, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar 80232, Bali
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BJOA.BJOA_115_20

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Coronavirus disease 2019 (COVID-19) is an infection caused by the severe acute respiratory syndrome-CoV-2 virus. The WHO declared COVID-19 as a global pandemic. There is a difference in the postoperative care of COVID-19 patients than ordinary patients. After surgery, the number of personnel transporting the patient must be as minimal as possible. The patient is treated in a particular room with negative pressure. The management of postoperative pain uses the principle of multimodal analgesia both types and techniques of administration. All infants born from mothers confirmed COVID-19 should be isolated from both the mother and other babies, and tested for COVID-19. Patients are advised to postpone the next pregnancy until the pandemic ends.

Keywords: Contraception, coronavirus disease 2019, newborn care, pain, postsurgery

How to cite this article:
Sastra Winata I G, Kurniawan PI. Postoperative management of obstetrics and gynecology patients in the coronavirus disease 2019 era. Bali J Anaesthesiol 2020;4, Suppl S2:36-8

How to cite this URL:
Sastra Winata I G, Kurniawan PI. Postoperative management of obstetrics and gynecology patients in the coronavirus disease 2019 era. Bali J Anaesthesiol [serial online] 2020 [cited 2021 Jun 23];4, Suppl S2:36-8. Available from: https://www.bjoaonline.com/text.asp?2020/4/6/36/297903

  Introduction Top

Coronavirus disease 2019 or COVID-19 is an infection caused by the severe acute respiratory syndrome-CoV-2 virus. The WHO declared COVID-19 as a global pandemic.[1] As of July 24, 2020, the total cases >15 million globally with >284,000 new cases every day. The number of deaths is 628,903 cases and 9753 death cases in the last 24 h.[2] A lot of those cases are obstetric and gynecological cases who need surgical treatment. Therefore, perioperative management must be comprehensive. This article will discuss the handling of problems in postoperative patients, both obstetric and gynecological patients in the COVID-19 era.

The priorities related to COVID-19 for obstetric and gynecologic patients are to treat pregnant women both asymptomatic and in critical condition, and to protect medical personnel from exposure during treatment (including health-care providers and family members). There are some distinct differences in the postoperative care of COVID-19 patients compared to other patients from both obstetric and gynecological patients.

  Postoperative Care Management Top

All patients managed with general anesthesia should stay in the operating room until fully conscious avoid aerosol spread.[3] The operating room must be sterilized according to internationally recognized standards. After the patient is transported to the treatment room, provide some time before subsequent patient care for the removal of airborne infectious contamination. The length of time depends on the number of air exchanges per hour in the specific operating room.[4]

To prevent transmission of the virus from patients to health-care workers, the number of personnel transporting postsurgical patients should be as minimal as possible. Transport personnel must use proper newly-worn personal protective equipment (PPEs), not the same PPE as they had used during the surgery.[3] The treatment room should be negatively pressurized.[5]

Postoperative COVID-19 patient care is multidisciplinary. An OBGYN specialist must collaborate with other physicians to treat the patient. Health-care workers who stationed in the COVID-19 postoperative care rooms must use at least level 2 PPE, and they should use level 3 PPE when they perform care to the patients.[6]

  Postoperative Pain Management Top

The management of postoperative pain using the principle of multimodal analgesia for both types and techniques of administration. An opioid-based analgesia drug can be given with the patient controlled analgesia technique. This technique is very good in controlling the analgesia needs of patients in pain, and reduce direct contact with health workers when given intermittently and intravenously.[7]

Local anesthesia can be given to postoperative patients from the upper abdomen to the legs with continuous epidural techniques to alleviate the inflammation and pain.[8] Patients who are intraoperatively facilitated with peripheral nerve block anesthesia techniques, using a peripheral nerve catheter is recommended so that it can be used as a modality of continuous postoperative pain therapy.[9] Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for postoperative pain management. Paracetamol infusion can be given as analgesia in all postoperative cases combined with opioids or local anesthesia.[10]

  Postoperative Drugs Management Top

In patients with severe infections, interferon or tocilizumab can be added to the treatment regime. Remdesavir might also play a role in oxygen therapy, and N-acetylcysteine should also be given.[11] NSAIDs and corticosteroids can be used under a specific condition.

Corticosteroids, especially dexamethasone, can be lifesaving for patients who are critically ill with COVID-19.[12] For patients on ventilators, the mortality was reduced by about one third, and for patients requiring only oxygen, the mortality was reduced by about one-fifth, according to preliminary findings shared with the WHO. However, these benefit was only seen in patients that seriously ill with COVID-19.[12],[13],[14]

  Management of Newborn Care Top

The principle of handling newborns from COVID-19 patients is to avoid transmission of the virus from mother to baby. Separate care must be employed for mothers who have been confirmed COVID-19 for 14 days or until the transmission risk limit has been exceeded.[5],[16] Temporary separation aims to reduce contact between the mother and the baby.[17],[18] All infants born to mothers who are confirmed to be COVID-19 must be placed in isolation and tested for COVID-19.[15],[19]

  Breastfeeding Management Top

Even though the COVID-19 mothers are placed separately from the baby, they are still encouraged to breast pump so that the baby can receive the benefits of breast milk. Another alternative is to consider asking someone for help in a healthy condition to breastfeed the baby.[20]

  Contraception Management Top

During the COVID-19 pandemic, patients should postpone the next pregnancy until the pandemic ends. All types of contraception can be used, including Intrauterine Device (IUD) after delivery. To make optimum use of these points of care, maternity units across the globe must urgently provide postpartum family planning services concentrating mainly on long-acting contraceptive methods which are more effective and reduce the need for return.[21]

  Conclusion Top

So far, limited data are known regarding COVID-19 infection concerning pregnancy and the fetus, and there are no specific recommendations. Therefore, the recommendations for the postoperative management of COVID-19 and non-COVID-19 patients among obstetric and gynecological patients above might change following the latest developments in the management of COVID-19.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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COVID-19 Information for Health Care Professionals Recommendations. American Society of Anesthesiologists; 2020. Available from: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus. [Last accessed on 2020 Jul 22].  Back to cited text no. 4
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Appendix 16 – Best Practice-Aide Memoire for Levels of Personal Protective Equipment (PPE) for Healthcare Workers when Providing Patient care. HPS; 2019. Available form: http://www.nipcm.hps.scot.nhs.uk/media/1437/2019-02-11-aide-memoire-for-levels-of-personal-protective-equipment-ppe-for-healthcare-workers-for-patient-care.pdf. [Last accessed on 2020 Jul 22].  Back to cited text no. 6
Wang R, Wang S, Duan N, Wang Q. From patient-controlled analgesia to artificial intelligence-assisted patient-controlled analgesia: Practices and perspectives. Front Med (Lausanne) 2020;7:145.  Back to cited text no. 7
Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: A case series of 17 patients. Can J Anaesth 2020;67:655-63.  Back to cited text no. 8
Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res Pract 2012;2012:560879.  Back to cited text no. 9
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Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. NIH; 2020. Available from: https://www.covid19treatmentguidelines.nih.gov/. [Last accessed on 2020 Jul 22].  Back to cited text no. 11
WHO Welcomes Preliminary Results about Dexamethasone Use in Treating Critically Ill COVID-19 Patients. WHO; 2020. Available from: https://www.who.int/news-room/detail/16-06-2020-who-welcomes-preliminary-results-about-dexamethasone-use-in-treating-critically-ill-covid-19-patients. [Last accessed on 2020 Jul 22].  Back to cited text no. 12
COVID-19 and NCDs: The use of Non-steroidal Antiinflammatory Drugs (NSAID) in Patients with COVID-19. WHO; 2020. Available from: https://www.who.int/publications/m/item/scientific-brief-on-the-use-of-non-steroidal-anti-inflammatory-drugs-(nsaid)-in-patients-with-covid-19. [Last accessed on 2020 Jul 23].  Back to cited text no. 13
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