Diagnosis and management of covid-19 in pregnancy

• Published in: BMJ (Online) Vol. 377; p. e069739
• Main Authors: Nana, Melanie, Hodson, Kenneth, Lucas, Nuala, Camporota, Luigi, Knight, Marian, Nelson-Piercy, Cathy
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 26.04.2022; BMJ Publishing Group LTD
• Subjects: Antiviral agents; Antiviral drugs; Clinical Review; Coronaviruses; Corticosteroids; COVID-19; COVID-19 - diagnosis; COVID-19 - therapy; Epidemiology; Ethnicity; Extracorporeal Membrane Oxygenation; Female; Fetuses; Glucocorticoids; Hispanic Americans; Hospitals; Humans; Infections; Intensive care; Interleukin 6; Intubation; Maternal mortality; Mechanical ventilation; Medical diagnosis; Minority & ethnic groups; Monoclonal antibodies; Morbidity; Noninvasive Ventilation; Oxygen; Oxygenation; Pandemics; Population; Pregnancy; Prophylaxis; Respiration, Artificial; Severe acute respiratory syndrome coronavirus 2; Systematic review; Thromboembolism; Ventilators; Womens health; United Kingdom > UK; United States > US
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj-2021-069739

AbstractPregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.