Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : UR01 - UR04 Full Version

Symptomatic COVID-19 Positive Parturients Posted for Lower Segment Caesarean Section


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/60591.17219
M Jisha, M Mohan David

1. Assistant Professor, Department of Anaesthesiology, Government Medical College, Palakkad, Kerala, India. 2. Associate Professor, Department of Anaesthesiology, Government Medical College, Palakkad, Kerala, India.

Correspondence Address :
Dr. M Jisha,
Nihir Near Yakkara Bridge, Yakkara PO., Palakkad-678701, Kerala, India.
E-mail: drjisham80@gmail.com

Abstract

Since the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic many elective cases were postponed worldwide. But emergency Lower Segment Caesarean Sections (LSCS) is one surgery which can’t be postponed at any cause, since two lives are at risk. The present case series reports 16 symptomatic COVID-19 patients in whom emergency LSCS was performed. The aim of presenting the series was to analyse how far the clinical and laboratory findings were deranged in such patients and to find out whether the current anaesthetic techniques were safe in these patients. Out of a total of 157 COVID-19 positive patients who had undergone LSCS in the study, 16 presented with symptoms such as fever, cough, dyspnoea, rhinitis, headache and palpitation. Six (37.5%) were preterm. Seven patients had elevated C-Reactive Protein (CRP) (>5 mg/L). Liver function tests abnormalities were seen in 5 (31.25%). Most of the patients had elevated D-dimer of which (>1500 ng/mL) were seen in seven. The most common indication was foetal distress. COVID pneumonia was an indication for LSCS in 3 (18.75%). All the surgeries were performed under subarachnoid block. Of the four patients who had fall in oxygen saturation two were admitted in Intensive Care Unit (ICU) and one required Non Invasive Ventilation (NIV). There were no mortalities. Thus, LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease.

Keywords

Anaesthesiology, Coronavirus disease-2019, Pregnancy, Spinal anaesthesia

The COVID-19 infection presents with a wide array of severity ranging from asymptomatic to severe pneumonia requiring ventilatory support. Pregnant women may be especially susceptible to respiratory pathogens because of the physiological changes in both their immune and cardiorespiratory systems making them intolerant to hypoxia. Symptoms of COVID-19 in pregnant patients are similar to non pregnant individuals (1). Neutrophilia, lymphopenia, elevated levels of D-dimer, CRP, serum transaminases, and other inflammatory markers like ferritin, procalcitonin are found in COVID parturients (1),(2). Spinal anaesthesia is safe in COVID-19 positive patients undergoing elective LSCS (3). Neuroaxial anaesthesia may be associated with exaggerated hypotension in COVID-19 parturients (4). General anaesthesia is less preferred in LSCS to avoid the aerosolisation of viral particles during endotracheal intubation and extubation (5). There is limited data on emergency LSCS in symptomatic COVID-19 patients.

Case Report

The series presents the symptomatic COVID-19 positive parturients admitted for emergency caesarean section, between March 2020 and February 2022. Of the total 157 COVID-19 positive LSCS, 16 patients presented with symptoms of coronavirus infection. The presenting symptoms like fever, headache, rhinitis, cough, breathlessness, and palpitation along with indication for surgery and any co-morbidities were noted. To avoid unnecessary exposure of radiation to mother and foetus, and due to patient overload Computed Tomography (CT) chest was done only in one patient.

Age of the 16 patients ranged from 19-38 years. The common presenting symptoms in these cases were cough, fever and dyspnoea. Six patients had preterm deliveries (37.5%), of which the shortest gestational age was 33 weeks and five days for case number seven. The indications for caesarean section in these patients were foetal distress (six patients), previous LSCS in labour (five patients), COVID-19 pneumonia (three patients), and one each for failed induction and meconium-stained amniotic fluid (Table/Fig 1).

Laboratory tests showed leukocytosis in five patients of which four had neutrophilia. Platelet count, random blood sugar, blood urea and creatinine were not deranged in these patients (Table/Fig 2). Liver function tests were deranged in five patients. D-dimer values were elevated between 500 ng/mL to a maximum value of 4690 ng/mL in eleven patients (Table/Fig 3) and CRP above 5 mg/L in seven patients. All surgeries were done under Lumbar Subarachnoid Block (LSAB) with 1.7 mL to 1.8 mL of 0.5% bupivacaine heavy with or without buprenorphine 30 μg. Intraoperative tachycardia was seen in case numbers 1, 12, 13 and 15. Blood pressure did not show fluctuations and mean blood pressure was maintained above 65 mmHg throughout. Oxygen saturation was maintained above 95% in case numbers 4,5,8,12 and 16 with the help of oxygen supplementation through face mask. Postoperative Intensive Care Unit (ICU) admission was needed in case numbers 12 and 16 of which case number 12 required NIV (Table/Fig 4). The duration of hospital stay ranged from a minimum of four days to a maximum of 15 days. No mortality occurred among these cases.

Discussion

Healthcare workers faced a new challenge with the onset of the novel Coronavirus infection. In spite of these challenges, emergency LSCS is one surgery which cannot be postponed at any cost. In the series, 16 symptomatic COVID-19 patients underwent LSCS successfully, without any perioperative mortality. Cough, fever, and dyspnoea were the common symptoms of these patients. Few studies have reported similar observations (6),(7). Foetal distress and previous LSCS patients in labour were the two common indications for emergency LSCS in the study. Aydin Güzey N and Uyar Türkyilmaz E, evaluated 254 caesarean sections in COVID-19 and the two common indications for surgery were foetal distress and previous LSCS patients in labour (8), this correlates with findings in the present study. In three patients the indication for LSCS was COVID-19 pneumonia to reduce further stress on already compromised lung. Preterm delivery and foetal distress were found to be more in third trimester in COVID-19, according to the analysis of Kapote D and Nayak AH (9). In the present series, there were six preterm deliveries.

The coronavirus infection can cause leukocytosis, neutrophilia, lymphopenia and thrombocytopenia (10). Four of the patients had leukocytosis with neutrophilia. The liver plays an essential role in host defense against microorganisms and is frequently involved in most systemic infections, as it receives a dual blood supply from the systemic and portal circulation (11). COVID-19 causes change in several liver biomarkers, which may be closely related to the severity of the disease (12). Elevated liver enzymes are associated with higher rates of preterm deliveries (13). Of the cases in the present case series, deranged liver function tests were found in 5 (31.25%). These include isolated elevation of bilirubin and elevation of both SGOT and SGPT. Also, in one patient only SGOT was elevated, while another patient had both abnormal bilirubin and transaminases level. One of the main mechanisms of liver damage in COVID-19 is the abundance of angiotensin converting enzyme-2 receptor in cholangiocytes and bile duct cells (14). Other causes are hepatic ischaemia, hypoxic reperfusion injury and drug induced hepatic injury. Further research is required to assess any correlation between elevated serum transaminases and perioperative morbidity in pregnant patients.

Pereira A et al., suggested that pregnant patients with severe COVID pneumonia had elevated levels of D-dimer and CRP. D-dimer is elevated in uncomplicated pregnancy as well (15). In the current study, seven patients had maximum D-dimer values above 1500 ng/mL of which two had values above 2500 ng/mL (Table/Fig 4). None of them had thrombotic complications even after LSCS. Of the two patients admitted in ICU postoperatively case number 12 had the highest D-dimer value of 4690 ng/mL and case number 16 had a D-dimer value of 1649.1 ng/mL. These findings show that D-dimer as such cannot be used to predict the severity of pneumonia in pregnancy. A CRP of ≥40 mg/L on admission to hospital should be seen as a reliable indicator of disease severity and increased risk of death (16). In this series, CRP levels of more than 5 mg/L was seen in seven (43.7%) patients-ranging from 6.4 to 33.06 mg/L. An interesting finding in case number seven was that the patient, a known case of bronchial asthma, presented with cough and rhinitis and had a peak D-dimer value of 2568 ng/L and CRP value of 33.06 mg/L, developed no desaturation and had only mild disease. Koumoutsea EV et al., (17) reported two cases of coagulopathy due to COVID-19 with elevated D-dimer without any features of pneumonia. Lack of standardisation of D-dimer values in pregnancy makes it interpretation difficult. But the potential prognostic values of D-dimer in pregnancy cannot be dismissed as such, but requires further investigation. Thromboelastography is an additional tool to assess the thrombotic complications (18).

All 16 patients underwent LSCS under spinal anaesthesia. General anaesthesia was not required in any. Four patients who presented with fever had tachycardia in the perioperative period, which later on subsided with antipyretics. None of them developed significant hypotension that couldn’t be managed with vasopressor bolus. Thus, it shows that even in patients with symptoms and deranged laboratory parameters LSAB can be safely performed in COVID-19.

Four patients who required oxygen therapy in the preoperative period to maintain a saturation above 95%, also tolerated the spinal anaesthesia very well. A few authors have demonstrated the safety of LSAB in COVID caesarean section (3),(19). The benefits of regional anaesthesia are reducing the worsening of respiratory function by intubation and mechanical ventilation and reducing the risk of exposure of health care professionals to coronavirus due to aerosol generation (20). Gahlot D et al., reported a case of LSCS in morbidly obese female successfully managed with LSAB and Total Intravenous Anaesthesia (TIVA) due to the undue prolongation of operative time (21).

Out of the four patients who required perioperative oxygen supplementation, 2 patients-case number 12 and 16 required ICU admission which constitutes 12.5% and 1 patient, case number 12 (6.25%) required NIV. Karasu D et al., (19) found 15% of symptomatic parturients required ICU follow-up which was similar to the present series. Studies showed 5-10% of pregnant patients require intubation and mechanical ventilation (22). No mortality was reported. In a cross-sectional study of COVID positive pregnant patients, by Asalkar M et al., (23) there were nine maternal deaths among 871 cases. All these patients presented with breathlessness and had elevated D-dimer along with leukocytosis. Mean duration of hospital stay in the present series was nine days.

It is difficult to generalise the conclusions due to limited number of patients. Comparison with asymptomatic cases and non COVID parturients are not done in the present study. Neonatal outcomes and vertical transmission of COVID-19 was not evaluated. Extensive laboratory investigations couldn’t be done due to the exhaustion of resources.

Conclusion

The LSCS can be done safely under subarachnoid block even in symptomatic COVID-19 parturients. Preterm deliveries are more common in these patients. Elevation of D-dimer is common in pregnancy and it does not always indicate severe COVID-19 disease. The interpretation of D-dimer values is difficult due to lack of standardisation in pregnancy and further research is required to predict the severity of the disease. Foetal distress and previous caesarean section are the most common indications of surgery. Postoperative ICU requirement and ventilatory support is less even though the patients have symptoms.

References

1.
Vaezi M, Mirghafourvand M, Hemmatzadeh S. Characteristics, clinical and laboratory data and outcomes of pregnant women with confirmed SARS-CoV-2 infection admitted to Al-Zahra tertiary referral maternity center in Iran: A case series of 24 patients. BMC Pregnancy and Childbirth. 2021;21(1):378. https:// doi.org/10.1186/s12884-021-03764-y. [crossref] [PubMed]
2.
Jamal S, Singh N. COVID-19 in pregnancy: An experience at a dedicated tertiary care COVID facility in western Uttar Pradesh. J South Asian Feder Obst Gynae. 2021;13(2):81-83. [crossref]
3.
Jan M, Bhat WM, Rashid M, Ahad B. Elective cesarean section in obstetric COVID-19 patients under spinal anaesthesia: A prospective study. Anesth Essays Res. 2020;14(4):611-14.
4.
Zhang Y, Chen R, Cao C, Gong Y, Zhou Q, Wei M, et al. The risk of neuraxial anaesthesia-related hypotension in covid-19 parturients undergoing cesarean delivery: A multicenter, retrospective, propensity score matched cohort study. Front Med (Lausanne). 2021;8:713733. [crossref] [PubMed]
5.
Landau R, Bernstein K, Ring LE. Anaesthesia considerations for pregnant people with COVID-19 infection. Clin Obstet Gynecol. 2022;65(1):179-88. [crossref] [PubMed]
6.
Ryan GA, Purandare NC, McAuliffe FM, Hod M, Purandare CN. Clinical update on COVID-19 in pregnancy: A review article. J Obstet Gynaecol Res. 2020;46(8):1235-45. [crossref] [PubMed]
7.
Boushra MN, Koyfman A, Long B. COVID-19 in pregnancy and the puerperium: A review for emergency physicians. Am J Emerg Med. 2021;40:193-98. [crossref] [PubMed]
8.
Aydin Güzey N, Uyar Türkyilmaz E. Evaluation of 254 cesarean sections with COVID-19 in terms of anaesthesia and clinical course: 1-year experience. J Anesth. 2022;36:514-23. https://doi.org/10.1007/s00540-022-03086-z. [crossref] [PubMed]
9.
Kapote D, Nayak AH. An experience with management of COVID-19 positive pregnant patients in a tertiary care institute. J South Asian Feder Obst Gynae. 2022;14(4):424-28. [crossref]
10.
Amgalan A, Othman M. Hemostatic laboratory derangements in COVID-19 with a focus on platelet count. Platelets. 2020;31(6):740-45. Doi: 10.1080/ 09537104.2020.1768523. Epub 2020 May 26. PMID: 32456506. [crossref] [PubMed]
11.
Can E, Oğlak SC, Ölmez F. Abnormal liver function tests in pregnant patients with COVID-19 - a retrospective cohort study in a tertiary center. Ginekol Pol. 2022;93:151-57. [crossref] [PubMed]
12.
Fan H, Cai J, Tian A, Li Y, Yuan H, Jiang Z, et al. Comparison of liver biomarkers in 288 COVID-19 patients: A mono-centric study in the early phase of pandemic. Front Med (Lausanne). 2021;7:584888. [crossref] [PubMed]
13.
Denizli R, Sakcak B, Farisogullari N, Peker MEM, Sinaci S, Kara O, et al. The impact of elevated liver enzymes and intrahepatic cholestasis of pregnancy on the course of COVID-19 in pregnant women. SN Compr Clin Med. 2022;4(1):184. Doi: 10.1007/s42399-022-01267-1. Epub 2022 Aug 11. PMID: 35971435; PMCID: PMC9366840. [crossref] [PubMed]
14.
Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. (PREPRINT), doi: 10.1101/2020.02.03.931766. [crossref]
15.
Pereira A, Cruz-Melguizo S, Adrien M, Fuentes L, Marin E, Perez-Medina T, et al. Clinical course of Coronavirus Disease-2019 (COVID-19) in pregnancy. Acta Obstet Gynecol Scand. 2020;99(7):839-47. [crossref] [PubMed]
16.
Stringer D, Braude P, Myint PK, Evans L, Collins JT, Verduri A, et al. COPE Study Collaborators. The role of C-reactive protein as a prognostic marker in COVID- 19. Int J Epidemiol. 2021;50(2):420-29. [crossref] [PubMed]
17.
Koumoutsea EV, Vivanti AJ, Shehata N, Benachi A, Le Gouez A, Desconclois C, et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost. 2020;18(7):1648-52. [crossref] [PubMed]
18.
Servante, J, Swallow G, Thornton JG, Myers B, Munireddy S, Malinowski AK, et al. Haemostatic and thrombo-embolic complications in pregnant women with COVID-19: A systematic review and critical analysis. BMC Pregnancy and Childbirth. 2021;21:108. https://doi.org/10.1186/s12884-021-03568-0. [crossref] [PubMed]
19.
Karasu D, Kilicarslan N, Ozgunay SE, Gurbuz H. Our anaesthesia experiences in COVID-19 positive patients delivering by cesarean section: A retrospective single-center cohort study. J Obstet Gynaecol Res. 2021;47(8):2659-65. [crossref] [PubMed]
20.
Ismail S, Aman A. Safe anaesthesia and analgesia for obstetric patients in COVID-19 pandemic. J Obstet Anaesth Crit Care. 2020;10:65-68. [crossref]
21.
Gahlot D, Wadhwa B, Saxena K. Use of TIVA as an adjuvant to SAB in a COVID- 19-positive parturient with morbid obesity posted for emergency caesarean section-A case report. MAMC J Med Sci. 2022;8:76-78.
22.
Lucarelli E, Behn C, Lashley S, Smok D, Benito C, Oyelese Y. Mechanical ventilation in pregnancy due to COVID-19: A cohort of three cases. Am J Perinatol. 2020;37(10):1066-69. [crossref] [PubMed]
23.
Asalkar M, Thakkarwad S, Rumani I, Sharma N. Prevalence of maternal mortality and clinical course of maternal deaths in COVID-19 pneumonia-A cross-sectional study. J Obstet Gynaecol India. 2022;72(3):208-17. Doi: 10.1007/s13224-021- 01545-3. Epub 2021 Oct 6. PMID: 34629786; PMCID: PMC8492816. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/60591.17219

Date of Submission: Oct 05, 2022
Date of Peer Review: Oct 28, 2022
Date of Acceptance: Nov 12, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 10, 2022
• Manual Googling: Nov 02, 2022
• iThenticate Software: Nov 07, 2022 (4%)

ETYMOLOGY: Author Origin

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