Background: There are few case reports describing maternal mortality and intensive care of the pregnant patient with COVID-19 infection. Case: A 27-year-old patient at 34 weeks of gestation was admitted for the evaluation of cough, fever, tachypnea, and oligohydramnios. The day of admission she underwent cesarean delivery for a non-reassuring fetal heart rate tracing. Over the next 6 days her clinical condition deteriorated, she developed multi organ system failure, and died despite aggressive supportive care. Conclusion: Although mortality related to COVID-19 in pregnancy has been rarely reported to date, we describe a case of progressive clinical deterioration postpartum despite aggressive supportive care. Management strategies specific for pregnant women have not been developed. In timing delivery, the obstetrician must consider the possibility that the inflammatory response associated with CD may increase the risk for multiorgan system failure in parturients with COVID-19 while recognizing that risks to the fetus may be higher in patients with COVID-19 than in other critically ill parturients. Vertical transmission of infection to the neonate did not occur in our case and has not been demonstrated in other pregnancies with COVID-19 disease.

guidance, 21G,1.5inch needle was inserted in-plane approach. Right Costoclavicular block was given with 15 ml of 0.75% Ropivacaine with 8 mg Inj. Dexamethasone and subcutaneous infiltration of 10 ml of 2% lignocaine with adrenaline for the blockade of intercostobrachial nerve and posterior cutaneous nerve of arm. Results Costoclavicular block is also effective in the blockade of upper trunk of brachial plexus due to chimney effect. In the infraclavicular region, the neurovascular plexus sheath forms longitudinal septae between the cords that limits the circumferential spread of local anesthetics resulting in sparing of phrenic nerve. The success of anesthetic block is higher with multiple injections compared to single injection technique. Conclusions Costoclavicular block is safer alternative for upper limb surgeries in case of polytrauma with compromised lung function.

Introduction Improved outcomes after liver transplantation contribute to a successful pregnancy and delivery in transplant recipients. Anesthesiology teams face challenges when providing perioperative care to patients who have a liver transplant and undergo cesarean delivery, which include: an increased rate of cesarean delivery, a high risk of infection, and a high risk of interaction between immunosuppressant and anesthetic drugs. Case outline We report the case of a 28-year-old patient with a liver transplant (from a live donor) who underwent elective cesarean delivery under neuraxial anesthesia. Appropriate anesthetic management is critical to ensure optimal perioperative maternal and fetal outcomes. Cardiovascular stability after neuraxial anesthesia was maintained with adequate perioperative intravenous fluid management and early vasopressor(s) administration to preserve hepatic perfusion. Multimodal postoperative analgesia was administered; however, caution is required when prescribing drugs that have the potential for hepatic and renal side effects. Conclusion Multidisciplinary team evaluation, planning, and preparation are vital for optimizing safe care and delivery of pregnant patients with transplanted organs.