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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.