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