Proning considerations in pregnancy
Prone positioning has been widely utilized in ARDS management before and
during the COVID-19 pandemic due to its demonstrated mortality
benefits(7). Despite the exponential growth of COVID-19 related
publications, there remains a paucity of research on proning in ARDS in
pregnancy(8), specifically in ARDS secondary to COVID-19(9). Proning in
pregnancy requires careful attention to often overlooked physiologic
changes in pregnancy and additional technical challenges accompanying a
gravid abdomen(10). However, the benefits of proning in pregnancy extend
even further than the previously described effects on mortality. When
normoxia cannot be maintained in a ventilated pregnant patient, delivery
is undertaken even at a preterm gestation. With proning and consequently
improved oxygenation, iatrogenic preterm delivery might be avoided.
The purpose of this manuscript is to demonstrate a proning technique
that was successfully used at our institution to avoid premature
delivery of the fetus while improving maternal outcomes. All technical
challenges are addressed in an instructional Video 1 and 2 with a
pregnant model with twin gestation at 32 weeks.