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. 2020 Jun 15;2(3):100154. doi: 10.1016/j.ajogmf.2020.100154

Table 5.

Tip sheet: hypoxia in pregnant patients with COVID-19

Supplemental oxygen (amount of oxygen delivered by each modality is modifiable and can be adjusted to patient’s needs; goal, O2≥95%):

  • NC 2–9 L → NRB 10–15 L → move to a negative pressure room

  • High-flow NC → CPAP → Intubation → ECMO

Acute decompensation (modify based on severity):
  • □

    Consider repeating baseline admission laboratory tests (CBC, BMP, LFTs, magnesium, phosphate, PT, PTT, fibrinogen, CRP, LDH, and D-dimer).

  • □

    Add procalcitonin.

  • □

    Assess for signs of cardiac injury (troponin and BNP) and consider echo.

  • □

    Assess acid base status.

  • □

    Continuous fetal monitoring as a sixth “vital sign”

  • □

    Monitor hourly intake and output.

  • □

    Assess for bacterial superinfection (repeat CXR, sputum culture, or blood culture).

  • □

    Left lateral vs prone positioning as tolerated

Antenatal corticosteroids:
  • •

    Weigh risk for potential worsening respiratory status vs potential fetal benefit.

  • •

    Consider if 24 0/7 to 33 6/7 weeks’ gestation and preterm delivery anticipated within 7 days.

  • •

    Do not recommend if >34 weeks’ gestation.

Delivery:
  • •

    Multidisciplinary and individualized decision

  • •
    <34 weeks’ gestation
    • □
      Maternal risk for decompensation needs to be weighed against fetal benefit of prolonging pregnancy
  • •
    >34 weeks’ gestation
    • □
      Consider delivery if acute respiratory distress despite supportive care or presence of significant comorbidities increasing risk for decompensation.

Checklist for pregnant women with hypoxia and acute decompensation (defined as rapidly increasing supplemental oxygen need to maintain O2 ≥95%).

BMP, basic metabolic panel; BNP, B-type natriuretic peptide; CBC, complete blood cell count; COVID-19, coronavirus disease 2019; CPAP, continuous positive airway pressure; CRP, C-reactive protein; CXR, chest x-ray; ECMO, extracorporeal membrane oxygenation; LDH, lactate dehydrogenase; LFT, liver function test; NC, nasal cannula; NRB, nonrebreather mask; PT, prothrombin time; PTT, partial thromboplastin time.

Vega. Inpatient management of COVID-19 in pregnancy. AJOG MFM 2020.