• Mary Catherine Tolcher, Jennifer R McKinney, Catherine S Eppes, David Muigai, Amir Shamshirsaz, Kalpalatha K Guntupalli, and Joseph L Nates.
• Divisions of Maternal-Fetal Medicine and Pulmonary and Critical Care Medicine, Baylor College of Medicine, and the Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care and Respiratory Care, the University of Texas MD Anderson Cancer Center, Houston, Texas.
• Obstet Gynecol. 2020 Aug 1; 136 (2): 259-261.

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has prompted expanded use of prone positioning for refractory hypoxemia. Clinical trials have demonstrated beneficial effects of early prone positioning for acute respiratory distress syndrome (ARDS), including decreased mortality. However, pregnant women were excluded from these trials. To address the need for low-cost, low-harm interventions in the face of a widespread viral syndrome wherein hypoxemia predominates, we developed an algorithm for prone positioning of both intubated and nonintubated pregnant women. This algorithm may be appropriate for a wide spectrum of hypoxemia severity among pregnant women. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the clinical manifestations of COVID-19. This syndrome can manifest as severe pneumonia complicated by hypoxemia and ARDS. Given the current global COVID-19 pandemic, with a large number of ARDS cases, there is renewed interest in the use of prone positioning to improve oxygenation in moderate or severe hypoxemia. Among the populations who can benefit from prone positioning are pregnant women experiencing severe respiratory distress, as long as the physiologic changes and risks of pregnancy are taken into account.

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