Anesthetic management of cesarean section in COVID-19-positive pregnant women in Japan: Three case reports and review of the literature

Cesarean delivery may be performed if a pregnant woman develops coronavirus disease 2019 (COVID-19) in the prenatal period; however, perioperative management is controversial. Herein, we report the anesthetic management of cesarean sections in three pregnant women with COVID-19. In addition, we reviewed the literature on perioperative anesthesia management in pregnant women with COVID-19. Three pregnant women between the 37th and 38th weeks of gestation developed COVID-19 and were transferred to our hospital for cesarean section. Intraoperative spinal anesthesia was administered, and postoperative analgesia included intravenous morphine. Postoperatively, all patients were administered anticoagulant therapy. We used a negative pressure-controlled operating room for the cesarean sections, and the staff used Level 3 personal protective equipment with N95 masks, face shields, double gloves, full-body gowns, and shoe covers. None of the operating room staff, including the anesthesiologist, were infected with COVID-19 due to patient care. Spinal anesthesia, rather than general anesthesia, is recommended for cesarean sections in pregnant women with COVID-19. In addition to the risk of thrombosis, it is necessary to manage anesthesia in pregnant women infected with COVID-19 while considering accessibility to the ward for postoperative management and familiarity of ward staff.