Header bg
  • Users Online: 195
  • Print this page
  • Email this page
Header bg

REVIEW ARTICLE Table of Contents  
Ahead of print publication
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

Click here for correspondence address and email

Date of Submission20-Jun-2020
Date of Decision20-Jul-2020
Date of Acceptance10-Aug-2020
Date of Web Publication05-Oct-2020
 

  Abstract 


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 URL:
Sastra Winata I G, Kurniawan PI. Postoperative management of obstetrics and gynecology patients in the coronavirus disease 2019 era. Bali J Anaesthesiol [Epub ahead of print] [cited 2021 Apr 22]. Available from: https://www.bjoaonline.com/preprintarticle.asp?id=297293





  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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ryalino C. Covid-19: What we know so far. Bali J Anaesthesiol 2020;4:1-2.  Back to cited text no. 1
  [Full text]  
2.
World Health Organization. Coronavirus Disease 2019 (COVID 19) Situation Report 54. Geneva: World Health Organization; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus2019/situation-reports [Last accessed on 2020 Jul 01].  Back to cited text no. 2
    
3.
Chen X, Liu Y, Gong Y, Guo X, Zuo M, Li J, et al. Perioperative management of patients infected with the novel coronavirus: Recommendation from the joint task force of the Chinese society of anesthesiology and the Chinese association of anesthesiologists. Anesthesiology 2020;132:1307-16.  Back to cited text no. 3
    
4.
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
    
5.
Senapathi TG, Ryalino C, Wiryana M, Hartawan IG, Pradhana AP. Perioperative safety during Covid-19 pandemic: A review article. Bali J Anaesthesiol 2020;4 (Suppl S1):8-12.  Back to cited text no. 5
    
6.
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
    
7.
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
    
8.
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
    
9.
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
    
10.
Russell B, Moss C, Rigg A, Van Hemelrijck M. COVID-19 and treatment with NSAIDs and corticosteroids: Should we be limiting their use in the clinical setting? Ecancermedicalscience 2020;14:1023.  Back to cited text no. 10
    
11.
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
    
12.
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
    
13.
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
    
14.
Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Ibuprofen use and clinical outcomes in COVID-19 patients. Clin Microbiol Infect 2020;26:1259.e5–1259.e7.  Back to cited text no. 14
    
15.
Practice Advisory: Novel Coronavirus 2019 (COVID-19). ACOG; 2020.  Back to cited text no. 15
    
16.
Coronavirus (COVID-19) Infection in Pregnancy Information for Healthcare Professionals. RCOG. 2020; Version 3. Available from: https://www.wfsahq.org/images/coronavirus-covid-19-infection-in-pregnancy-v3-20-03-18.pdf. [Last accessed on 2020 Jul 23].  Back to cited text no. 16
    
17.
Senapathi TG, Ryalino C, Raju A, Winata IG, Hartawan IN, Hartawan IG. Perioperative management for cesarean section in COVID-19 patients. Bali J Anaesthesiol 2020;4 (Suppl S1):13-6.  Back to cited text no. 17
    
18.
Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020;222:415-26.  Back to cited text no. 18
    
19.
Queensland Government. Department of Health. Maternity care for Mothers and Babies during the COVID-19 Pandemic. Queensland Clinical Guidelines; 2020. Available from; https://www.health.qld.gov.au/__data/assets/pdf_file/0033/947148/g-COVID-19.pdf. [Last accessed on 2020 Jul 23].  Back to cited text no. 19
    
20.
Care for Breastfeeding Women Interim Guidance on Breastfeeding and Breast Milk Feeds in the Context of COVID-19. CDC; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/care-for-breastfeeding-women.html. [Last accessed on 2020 Jul 23].  Back to cited text no. 20
    
21.
COVID-19 Contraception and Family Planning. FIGO; 2020. Available from: https://www.figo.org/sites/default/files/2020-05/COVID%20contraception.pdf. [Last accessed on 2020 Jul 23].  Back to cited text no. 21
    

Top
Correspondence Address:
I Gde Sastra Winata,
Department of Obstetric and Gynaecology, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar 80232, Bali
Indonesia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BJOA.BJOA_115_20





 

Top
 
  Search
 
   Ahead Of Print
  
 Article in PDF
     Search Pubmed for
 
    -  Sastra Winata I G
    -  Kurniawan PI


Abstract
Introduction
Postoperative Ca...
Postoperative Pa...
Postoperative Dr...
Management of Ne...
Breastfeeding Ma...
Contraception Ma...
Conclusion
References

 Article Access Statistics
    Viewed210    
    PDF Downloaded8    

Recommend this journal