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Managing COVID-19 in pregnant women

Siara Teelucksingh, Melanie Nana, Catherine Nelson-Piercy
Breathe 2022 18: 220019; DOI: 10.1183/20734735.0019-2022
Siara Teelucksingh
1Dept of Obstetric Medicine, St Thomas’ Hospital, London, UK
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  • For correspondence: siara.teelucksingh@gstt.nhs.uk
Melanie Nana
1Dept of Obstetric Medicine, St Thomas’ Hospital, London, UK
2Dept of Women and Children's Health, King's College London, London, UK
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Catherine Nelson-Piercy
1Dept of Obstetric Medicine, St Thomas’ Hospital, London, UK
2Dept of Women and Children's Health, King's College London, London, UK
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    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.

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  • TABLE 1

    Pharmacological therapy used in the treatment of COVID-19 in pregnancy

    ClassDrugDurationIndicationEvidence base
    CorticosteroidPrednisolone 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 daysFor 10 days or until discharge from hospital (individualised in the ICU setting)Oxygen saturation <94% on room air or need for supplemental oxygenSignificant reduction in 28-day mortality [11]
    IL-6 receptor antagonistTocilizumab 8 mg·kg−1 or sarilumab 400 mgAdministered once only by intravenous infusionCRP ≥75 mg·L−1 and oxygen requirement or admission to critical careReduction in 60-day mortality; possible reduced progression to intubation [12]
    Neutralising monoclonal antibodyCasirivimab and imdevimabPatients 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 infusion
    Delta variant; SARS-CoV-2 IgG negativeReduction in 28-day mortality in patients admitted to hospital who were seronegative at baseline [13]
    Neutralising monoclonal antibodySotrovimab 500 mgAdministered as a single intravenous infusion over 30 minNon-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 antibodyTixagevimab 300 mg i.m. and cilgavimab 300 mg i.m.Administered as separate, consecutive intramuscular injectionsNot 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]
    AntiviralRemdesivir3-day course i.v.: 200 mg on day 1 and 100 mg on days 2 and 3Not routinely recommended; may be considered in women who are deteriorating despite standard management and have a non-omicron genotypeReduces 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.

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    Managing COVID-19 in pregnant women
    Siara Teelucksingh, Melanie Nana, Catherine Nelson-Piercy
    Breathe Jun 2022, 18 (2) 220019; DOI: 10.1183/20734735.0019-2022

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    Managing COVID-19 in pregnant women
    Siara Teelucksingh, Melanie Nana, Catherine Nelson-Piercy
    Breathe Jun 2022, 18 (2) 220019; DOI: 10.1183/20734735.0019-2022
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      • COVID-19 in pregnancy
      • Severity of COVID-19 disease
      • Pharmacological management of COVID-19 in pregnancy
      • Maternal and fetal monitoring
      • Mode and timing of delivery
      • Follow-up
      • COVID-19 vaccination
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