Prone Ventilation in a 27 Week Pregnant Woman with COVID-19 Severe ARDS

Pregnant women are more sensitive to respiratory pathogens due to the physiological changes related to pregnancy with an increase in morbidity and mortality. Pregnancy and childbirth do not seem to aggravate the course of symptoms of COVID-19 pneumonia. However, reports on optimal management of severe COVID-19-related ARDS during pregnancy are still lacking. To our knowledge only two case reports describe prone ventilation in pregnant women with severe ARDS, no one related to COVID-19. We report the case of a COVID-19 related severe ARDS in a 48-year-old woman in the last trimester of pregnancy. The patient required intensive care hospitalization for 20 days and invasive mechanical ventilation for 15 days. Pronation maneuver during mechanical ventilation relieved hypoxia and prevented mother and fetus damages, thus avoiding an urgent cesarean section and a premature birth. The patient was successfully discharged from the hospital without maternal and fetal sequelae. In our experience prone ventilation can be safely used to improve respiratory gas exchanges in the last trimester of pregnancy in case of severe ARDS.