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).