Perioperative Management in Parturient with Severe Preeclampsia, Obesity, and COVID-19

Rafael Bagus Yudhistira, Muhammad Yurizar Yudhistira, Raden Theodorus Supraptomo


The elevated cases of pregnant women infected with COVID-19 who needed to undergo caesarean section is a great challenge to anesthesiologists. Morbid obesity and preeclampsia in pregnancy are also another challenge to medical practice especially when the patient requires caesarean section. To describe the perioperative management of a morbidly obese preeclamptic patient with COVID-19. A pregnant woman with mild case of COVID-19, severe preeclampsia and obesity underwent an emergency caesarean section. Spinal anesthesia was performed using a Whitacre 26G spinal needle with 76 mm length, bupivacaine 0.5% 12.5 mg as spinal anesthesia agent and fentanyl 25 mcg as adjuvant. All operating teams use PPE according to COVID-19 guidelines and standard procedures. The operation went with a good outcome without any transmission to the operating team. The patient underwent treatment without postoperative complications. Spinal anesthesia is considered safe to be a usual technique for parturient with preeclampsia and morbid obesity. A proper COVID-19 surgery protocol is crucial in order to protect health workers handling COVID-19 patients.


COVID-19; obesity; perioperative management; severe preeclampsia; spinal anesthesia

Full Text:



1. Todros T, Masturzo B, Francia S De. COVID-19 infection: ACE2, pregnancy and preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2020 Oct 1 [cited 2021 Jul 25];253:330.

2. Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, García-May PK, Mhatre M, et al. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol. 2021 Jun [cited 2021 Jul 25];0(0).

3. Phipps E, Prasanna D, Brima W, Jim B. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Neprol. 2016;11:1102–1113.

4. Cai Q, Chen F, Wang T, Luo F, Liu X, Wu Q, et al. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. Diabetes Care. 2020;43(7):1392–8.

5. Longinus EN, Benjamin L, Omiepirisa BY. Spinal Anaesthesia for Emergency Caesarean Section in a Morbid Obese Woman with Severe Preeclampsia. Case Rep Anesthesi. 2012 [cited 2021 Sep 10];2012:1–3.

6. Harenberg JL, Church R, Tubog TD. Anesthesia Considerations of a Pregnant Woman With COVID-19 Undergoing Cesarean Delivery: A Case Report. AANA J. 2020;88(4):47–53.

7. Katipana M, Wiryana M, Tjahya Aryasa E, Pradhana A. Perioperative management in obstetric patients with suspected COVID-19 at Bali, Indonesia: Case series. Bali J Anesthesiol. 2021;5(1):40.

8. Paranjothy S, Griffiths JD, Broughton HK, Gyte GM, Brown HC, Thomas J. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. In: Paranjothy S, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010 [cited 2021 Oct 3].

9. Burhan E, Susanto AD, Nasution SA, Ginanjar E, Pitoyo CW, Susilo A, et al. Protokol Tatalaksana Covid-19. 1. 2020.

10. Lima RM e, Reis L de A, Thyrso de Lara FS, Dias LC, Matsumoto M, Mizubuti GB, et al. Recommendations for local-regional anesthesia during the COVID-19 pandemic. Brazilian J Anesthesi (English Ed. 2020 Mar 1;70(2):159–64.

11. Hani DAB, Alsharaydeh I, Bataineh AM, Athamneh M Al, Qamileh I, Al-Baik A, et al. Successful Anesthetic Management in Cesarean Section for Pregnant Woman with COVID-19. Am J Case Rep. 2020 [cited 2021 Sep 10];21:e925512-1.

12. D’Alonzo R, White W, Schultz J, Jaklitsch P, Habib A. Ethnicity and the Distance to the Epidural Space in Parturients. Reg Anesth Pain Med. 2008 Jan [cited 2021 Oct 3];33(1):24–9.

13. Singla M, Santpur M, Khan MA, Singh S. A Clinical Study to Compare 25 G Whitacre and Quincke Spinal Needles for Incidence of Post Dural Puncture Headache (PDPH) and Failed Spinal Anaesthesia. Indian J Public Heal Res Dev. 2020 May 24;11(05):216–20.

14. Lee Y, Balki M, Parkes R, Carvalho JCA. Dose Requirement of Intrathecal Bupivacaine for Cesarean Delivery Is Similar in Obese and Normal Weight Women. Brazilian J Anesthesiol. 2009 Nov [cited 2021 Oct 3];59(6):674–83.

15. Ingrande J, Brodsky JB, Lemmens HJM. Regional anesthesia and obesity. Curr Opin Anaesthesiol. 2009 Oct;22(5):683–6.


  • There are currently no refbacks.