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Table 2 Escalation plan for management of pregnant woman with COVID-19 infection in our institution (adapted from RCOG guideline)

From: Preparation and consideration for establishment of an isolation maternity unit in a tertiary hospital during COVID-19 pandemic

Clinical Category

Clinical criteria

Action plans in our institution

Green

• SpO2 94–100% on RA and RR ≤ 20

• Ensure no obstetric/fetal or other medical concerns

• Consider discharging when woman is out of acute phase of illness and low infectious status

• COVID specific treatment

■ Consider role of monoclonal antibody (sotrovimab, casirivimab+imdevimab) or short course intravenous remdesivir for unvaccinated/seronegative womenearly in illness onset with co-morbidities who are deemed at high risk of progression to severe illness.

Yellow

• SpO2 94–100% on FiO2 ≥ 28%

• Assessment by multidisciplinary team

Discuss timing of birth and delivery plans

Assessment by infectious disease specialists

• Depending on the gestational age

Consider steroids for fetal lung maturity (if at risk of preterm delivery < 35 + 6 weeks)

Consider magnesium sulfate for neuroprotection (if at risk of preterm delivery < 34 weeks)

• COVID specific treatment

Dexametasone +/− Remdesivir

Amber

• SpO2 94–100% on FiO2 ≥ 35%

• Assessment by multidisciplinary team

Refer to ICU team

Discuss the risk and benefits of emergency caesarean birth

• Depending on the gestational age

Consider steroids for fetal lung maturity (if at risk of preterm delivery < 35 + 6 weeks)

Consider magnesium sulfate for neuroprotection (if at risk of preterm delivery < 34 weeks)

• COVID specific treatment

Dexametasone +/− Remdesivir

Consider tocilizumab for women at high risk of or who are exhibiting rapid respiratory decompensation due to COVID-19 associated systemic hyperinflammation.

Consider use of high flow oxygen

Consider awake proning position when feasible

Red

• SpO2 < 94% on FiO2 ≥ 60%

• Assessment by multidisciplinary team

Urgent review by ICU team and obstetric team

Discuss timing of intubation

Discuss risk and benefits of emergency caesarean birth for maternal resuscitation

• Depending on the gestational age

Consider steroids for fetal lung maturity (if at risk of preterm delivery < 35 + 6 weeks)

Consider magnesium sulfate for neuroprotection (if at risk of preterm delivery < 34 weeks)

• COVID specific treatment

Consider early intubation

Dexamethasone +/− Remdesivir

Consider tocilizumab for women at high risk of or who are exhibiting rapid respiratory decompensation due to COVID-19 associated systemic hyperinflammation.