Conclusion
Among the complexity of managing a pregnant intubated patient, COVID-19
adds additional challenges(26). With multiple treatment strategies going
amiss(27), proning remains a well-proven intervention in ARDS and should
be considered in pregnant women when indicated. In our case series, we
were able to improve the P/F ratio while decreasing FiO2and avoid iatrogenic preterm delivery. Except for the case where the
patient self-extubated and required emergent delivery, all patients were
successfully extubated, followed for prenatal care, and delivered for
usual obstetric indications. We recognize that proning might not be
effective in all cases. However, based on its proven benefit in the
non-pregnant population(7) and the available evidence in the pregnant
population(8, 10, 13, 14), proning positioning is an option to improve
oxygenation in patients with severe hypoxemia when the next
consideration is delivery of a premature infant or maternal ECMO
cannulation.