Volume 30, Issue 2 (4-2023)                   RJMS 2023, 30(2): 0-0 | Back to browse issues page

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Alimian M, Ghaemi M, Amir Aslani T. Investigating the effect of Covid-19 on obstetrics and gynecology anesthesia and providing recommendations and guidelines: A systematic review. RJMS 2023; 30 (2)
URL: http://rjms.iums.ac.ir/article-1-7528-en.html
Assistant Professor, Department of Anesthesiology, Hazrat Rasoul Akram Educational Complex, Iran University of Medical Sciences. , ghaemi.moh@iums.ac.ir
Abstract:   (109 Views)
Background and Aim: Covid-19 has a high mortality rate worldwide due to its high transmissible nature. Although selective procedures may be delayed to prevent exposure to and save on personal protective equipment or other medical treatment in quarantine, midwifery activities may not be delayed. Pregnant women are more susceptible to Covid-19 infection due to physiological changes in their immune and cardiovascular systems. Therefore, special care is needed for pregnant women before, during and after a normal delivery or cesarean section. There are two goals in caring for women infected with Covid-19, as well as those suspected of having Covid-19 infection, caring for pregnant and postpartum women in asymptomatic to severely ill mothers and preventing exposure to physicians, and other people during childbirth. In the last two years since the start of Covid-19, it has been observed that a large number of people have contracted the disease, which has increased the demand for hospitals, intensive care units and hospital staff, including nurses and anesthesiologists. Anesthesiologists did not have this condition before the epidemic. They are not trained to deal with infected mothers. Therefore, some preventive measures should have been taken by anesthesiologists. This study summarizes how anesthesiologists should prepare themselves for such epidemics. The clinical features of Covid-19 are of great importance in pregnant women. Pregnant women show similar symptoms of Covid-19 that are not seen in healthy non-pregnant women. However, most of these characteristic symptoms can be related to the symptoms of pregnancy and childbirth. Muscle aches and diarrhea are common symptoms of labor. In addition, preeclampsia can cause severe headaches. Breathing problems are common during pregnancy and childbirth. In addition, tachycardia and fever can be caused by chorioamnionitis. All of these symptoms cause doctors to ignore Covid-19 infection as a possible disease. In addition, women infected with Covid-19 may be asymptomatic until they are hospitalized for delivery. This poses a significant risk of transmitting the virus to the patient's family (infant) and any health care personnel involved in their care. With the increasing incidence of coronavirus 2019 (Covid-19) worldwide, preparation for uncertain delivery conditions has become more important than ever. Therefore, in the present study, an attempt has been made to summarize the findings of the studies to provide strong evidence in this regard and to use the results in the forthcoming epidemics. The aim of this study was to evaluate the effect of Covid-19 on obstetrics and gynecology anesthesia.
Methods: The present study is a systematic review and meta-analysis written based on the PRISMA guideline. Related articles were searched in PubMed, Scopus, Web of Science, EBSCO and Embase databases from December 19, 2019 until the end of April 2022. Keywords obstetrics and gynecology anesthesia, Covid-19, anesthesia, epidemic, anesthesiologists in Covid-19 were used to search for relevant data. Obstetrics and Gynecology (RCOG), the Society of Obstetrics and Gynecology Anatomy and Perinatology (SOAP) and the American Society of Anesthesiologists (ASA) were also surveyed. In this study, it was determined that only the reviewed articles on practical recommendations and consideration of gynecological anesthesia in the COVID-19 epidemic should be included in this study. First, the search was performed using primary keywords and 253 studies were found in the database. After removing duplicate studies from databases, 222 studies were selected for review. After studying the abstract according to the study criteria, 177 articles were deleted and the full text of 45 articles was reviewed. Then 30 articles were deleted at this stage and only 15 studies were selected for review
Findings: This study provides possible recommendations for obstetricians and gynecologists when dealing with infected patients, and these recommendations help prepare for future epidemics. Treatment or treatment of patients positive or suspected of Covid-19 requires PPE. Airborne precautions are recommended for aerosol production methods (AGPs). Deep exhalation during labor and pressure during labor do not produce aerosols. Even in an emergency, the most skilled anesthesia provider should perform spinal anesthesia to prevent unsuccessful attempts as well as the need to switch to general anesthesia.
Conclusion: Based on the findings of studies, COVID-19 positive pregnant women are a serious threat to anesthesia providers and other medical staff. There is a need to develop intensive care instructions and steps to prepare anesthesiologists. Special programs and joint guidelines should be developed to train maternity ward staff for such scenarios. Various recommendations and publications on the safety of neurosurgery in pregnant women COVID-19 have been published to guide medical staff. Just because health care centers focus heavily on COVID-19 today does not mean that common health care standards in other sectors should be ignored. In 2016, during the Ebola epidemic, it was estimated that due to the outbreak of the disease, there was a significant reduction in postpartum and prenatal care in women in health care centers. This further reduction resulted in a 34% increase in the mortality rate associated with center-related maternal mortality and a 24% increase in stillbirths. There is an urgent need for health care professionals to ensure that, even in epidemic situations, the consequences for the fetus as well as the mother should not be affected.
Type of Study: Research | Subject: Clinical Psychiatry

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