Department of anestheiology and pain medicine, Inje University Seoul Paik Hospital, Seoul, Korea

Background and Aims The incidence of hypotension in pregnant women with COVID-19 undergoing regional anesthesia remains a controversial. The aim of this study is to investigate the incidence of hypotension during spinal anesthesia in pregnant women infected with COVID-19, as well as to identify associated risk factors.

Methods This retrospective study compared COVID-19-positive parturients who underwent cesarean section with spinal anesthesia between January 2021 and June 2022 (group COVID-19) with a control group of patients who underwent the same procedure between January 2017 and December 2021 and were statistically matched for age, weight, and height with the group COVID-19.

Results The COVID-19 group received low-dose bupivacaine anesthesia and showed comparable levels of anesthesia and blood pressure reduction to the control group. However, they required more colloid usage. A positive correlation was noted in the COVID-19 group between heart rate and hospital stay duration (p=0.000, Spearman’s rho= 0.422). Further analysis based on initial heart rate revealed that group H (100 or higher) had lower Apgar scores at 1 minute, longer hospital stays, and more severe COVID-19 symptoms. Moreover, in group H, there was a positive correlation between heart rate and the lowest systolic blood pressure after spinal anesthesia (p=0.012, Spearman’s rho=0.528).

Conclusions COVID-19 pregnant women have a higher risk of hypotension during cesarean section under spinal anesthesia compared to non-COVID-19. Given the close association between preoperative heart rate and the extent of hypotension in COVID-19 pregnant women undergoing spinal anesthesia, vigilant monitoring of vital sign by anesthesiologists is crucial during the perioperative period.

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