Diagnosis and management of covid-19 in pregnancy

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 fo...

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Bibliographic Details
Published in:BMJ (Online) 2022-04, Vol.377, p.e069739-e069739
Main Authors: Nana, Melanie, Hodson, Kenneth, Lucas, Nuala, Camporota, Luigi, Knight, Marian, Nelson-Piercy, Cathy
Format: Article
Language:English
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
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Summary: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.
ISSN:1756-1833
1756-1833
DOI:10.1136/bmj-2021-069739