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Am J Perinatol 2020; 37(10): 1044-1051
DOI: 10.1055/s-0040-1713121
Clinical Opinion
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Putting It All Together: Clinical Considerations in the Care of Critically Ill Obstetric Patients with COVID-19

Corrina Oxford-Horrey 
1   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Megan Savage
1   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Malavika Prabhu
1   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Sharon Abramovitz
2   Department of Medicine/Critical Care, Weill Cornell Medicine, New York, New York
,
Kelly Griffin
3   Department of Anesthesiology, Weill Cornell Medicine, New York, New York
,
Elyse LaFond
3   Department of Anesthesiology, Weill Cornell Medicine, New York, New York
,
Laura Riley
1   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
,
Sarah Rae Easter
4   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding None.
Further Information

Publication History

13 May 2020

15 May 2020

Publication Date:
23 June 2020 (online)

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Abstract

Pregnant patients with severe acute respiratory syndrome coronavirus 2, the virus responsible for the clinical condition newly described in 2019 as coronavirus disease 2019 (COVID-19) and illness severity to warrant intensive care have a complex disease process that must involve multiple disciplines. Guidelines from various clinical societies, along with direction from local health authorities, must be considered when approaching the care of an obstetric patient with known or suspected COVID-19. With a rapidly changing landscape, a simplified and cohesive perspective using guidance from different clinical society recommendations regarding the critically-ill obstetric patient with COVID-19 is needed. In this article, we synthesize various high-level guidelines of clinical relevance in the management of pregnant patients with severe disease or critical illness due to COVID-19.

Key Points

  • When caring for severely ill obstetric patients with COVID-19, one must be well versed in the complications that may need to be managed including, but not limited to adult respiratory distress syndrome with need for mechanical ventilation, approach to refractory hypoxemia, hemodynamic shock, and multiorgan system failure.

  • Prone positioning can be done safely in gravid patients but requires key areas of support to avoid abdominal compression.

  • For the critically ill obstetric patient with COVID-19, the focus should be on supportive care as a bridge to recovery rather than delivery as a solution to recovery.

Keywords

COVID-19 - adult respiratory distress syndrome - pregnancy - critical care - shock
 

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