Interpretation of the results
Similar to their non-pregnant counterparts, pregnant patients with ARDS
related to COVID-19 experience benefit in the use of prone positioning.
For a syndrome with few therapies available, proning becomes a crucial
maneuver that benefits the mother and the fetus by avoiding an
iatrogenic preterm delivery during worsening respiratory status.
To our knowledge, this is the first manuscript presenting a detailed
description of proning in pregnancy that is supported by institutional
experience. Moreover, we had a uniform multidisciplinary approach to the
management of ARDS in pregnant patients with COVID-19. In the
instructional Video 1, we demonstrate how the challenges of proning in
pregnancy are easily overcome when performed by a well-trained staff,
even at late gestation. The latest gestation at which proning was
described in a critically ill patient is 34 weeks in singleton(14).
However, studies in healthy individuals that evaluated maternal-fetal
hemodynamic parameters are described as far as 37 weeks(15). None of our
patients that were proned suffered any complications during proning.
The limitations of our findings are inherited from the sample size and
retrospective nature. While these limitations might restrict the
generalizability, it is important to weigh the risks of an intervention
or treatment against the risk of withholding its benefits, as
”protection by exclusion” of pregnant women from research and
therapeutic interventions ultimately might negatively affect their
health(16).