Figures
- FIGURE 1
Approach to clinical management of women with COVID-19 who are pregnant or up to 6 weeks postpartum. SpO2: oxygen saturation measured by pulse oximetry; RR: respiratory rate; CPAP: continuous positive airway pressure; VTE: venous thromboembolism; RCOG: Royal College of Obstetricians and Gynaecologists; ACOG: American College of Obstetricians and Gynecologists; LMWH: low molecular weight heparin; MDT: multidisciplinary team; ICU: intensive care unit; CRP: C-reactive protein; ECMO: extracorporeal membrane oxygenation. Reproduced and modified from [4] with permission.
Tables
- TABLE 1
Pharmacological therapy used in the treatment of COVID-19 in pregnancy
Class Drug Duration Indication Evidence base Corticosteroid Prednisolone 40 mg once daily, or hydrocortisone 80 mg twice daily, or methylprednisolone 1 mg·kg−1 twice daily for 5–7 days followed by once daily for 5–7 days For 10 days or until discharge from hospital (individualised in the ICU setting) Oxygen saturation <94% on room air or need for supplemental oxygen Significant reduction in 28-day mortality [11] IL-6 receptor antagonist Tocilizumab 8 mg·kg−1 or sarilumab 400 mg Administered once only by intravenous infusion CRP ≥75 mg·L−1 and oxygen requirement or admission to critical care Reduction in 60-day mortality; possible reduced progression to intubation [12] Neutralising monoclonal antibody Casirivimab and imdevimab Patients hospitalised with COVID-19: 2.4 g as a combined single intravenous infusion
Patients with hospital-onset COVID-19: 1.2 g as a combined single intravenous infusionDelta variant; SARS-CoV-2 IgG negative Reduction in 28-day mortality in patients admitted to hospital who were seronegative at baseline [13] Neutralising monoclonal antibody Sotrovimab 500 mg Administered as a single intravenous infusion over 30 min Non-hospitalised patients with mild to moderate disease who are considered very high risk for disease progression [14] Reduces the risk of hospitalisation or death by 70–85% [1, 15] Neutralising monoclonal antibody Tixagevimab 300 mg i.m. and cilgavimab 300 mg i.m. Administered as separate, consecutive intramuscular injections Not routinely given; the MHRA supports its use where the expected benefits outweigh the potential risks [16] Pre-exposure immunoprophylaxis in adults who have an increased risk of an inadequate response to vaccination, increased risk of exposure, or both [16] Antiviral Remdesivir 3-day course i.v.: 200 mg on day 1 and 100 mg on days 2 and 3 Not routinely recommended; may be considered in women who are deteriorating despite standard management and have a non-omicron genotype Reduces the risk of hospitalisation or death by 85–90% [17, 18] ICU: intensive care unit; IL: interleukin; CRP: C-reactive protein; MHRA: Medicines and Healthcare products Regulatory Agency.
