Severe ARDS in COVID-19-infected pregnancy: obstetric and intensive care considerations

Schnettler, William T.; Al Ahwel, Yousef; Suhag, Anju

Abstract Since the emergence of a novel coronavirus (SARS-CoV-2) in Wuhan, China, at the end of December 2019, its infection – COVID-19 – has been associated with severe morbidity and mortality and has left world governments, healthcare systems and providers caring for vulnerable populations, such as pregnant women, wrestling with the optimal management strategy. Unique physiologic and ethical considerations negate a one-size-fits-all approach to the care of critically ill pregnant women with COVID-19, and few resources exist to guide the multi-disciplinary team through decisions regarding optimal maternal-fetal surveillance, intensive care procedures, and delivery timing. We present a case of rapid clinical decompensation and development of severe Acute Respiratory Distress Syndrome (ARDS) in a woman at 31 weeks’ gestation to highlight these unique considerations and present an algorithmic approach to the disease’s diagnosis and management.