Postoperative management of obstetrics and gynecology patients in the coronavirus disease 2019 era Sastra Winata I G, Kurniawan PI,

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

I Gde Sastra Winata, Polo Ishak Kurniawan
Department of Obstetric and Gynaecology, Faculty of Medicine, Udayana University, Bali, Indonesia

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Date of Submission	20-Jun-2020
Date of Decision	20-Jul-2020
Date of Acceptance	10-Aug-2020
Date of Web Publication	05-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

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

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

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

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

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

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

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

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.

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