Consideration for delivery
In general, delivery should not be performed for the sole reason to improve oxygenation(12). Instead, the delivery decision should balance the risks of neonatal prematurity and the risks of exposing the fetus to intractable maternal hypoxemia. Some authors have suggested a threshold of 28-32 weeks(13, 22). At our institution, we first exhaust maximum ventilatory settings, prone position, and potentially extracorporeal membrane oxygenation. The mode of delivery is based on standard obstetrical indications. Induction of labor in a preterm ventilated patient with COVID-19 has been described(23). Whereas cesarean delivery allows a faster and controlled delivery, it has been associated with significant maternal mortality in ventilated patients(24).
Regardless of the planned mode of delivery, all the supplies necessary for cesarean delivery and neonatal resuscitation should be set up inside the biocontainment unit. A portable neonatal and surgical station in close proximity allows for emergent delivery and neonatal resuscitation if necessary.