Pregnant Patients and COVID-19

Mahendra, Vibha; Murugan, Shobana

The management of COVID-19 disease in pregnancy requires an understanding of the physiology of pregnancy, the fetoplacental unit, and the ability to adapt critical care principles to this unique population. Though the majority of pregnant patients who test positive for SARS-CoV-2 remain asymptomatic or have mild disease and recover without undergoing delivery (Wu and McGoogan, JAMA 323(13), 2020), a significant number develop critical illness and may have prolonged and complex disease courses (Huntley et al., Obstet Gynecol. 2020). Decision-making in these patients can be challenging and requires a multidisciplinary approach involving intensivists, obstetricians/maternal-fetal medicine specialists, anesthesiologists, and neonatologists. Here we discuss current recommendations surrounding identification of high-risk patients, the safety of investigational therapies, controversial topics in management, and evidence-based care of critically ill parturients.