Proning considerations in pregnancy
Prone positioning has been widely utilized in ARDS management before and during the COVID-19 pandemic due to its demonstrated mortality benefits(7). Despite the exponential growth of COVID-19 related publications, there remains a paucity of research on proning in ARDS in pregnancy(8), specifically in ARDS secondary to COVID-19(9). Proning in pregnancy requires careful attention to often overlooked physiologic changes in pregnancy and additional technical challenges accompanying a gravid abdomen(10). However, the benefits of proning in pregnancy extend even further than the previously described effects on mortality. When normoxia cannot be maintained in a ventilated pregnant patient, delivery is undertaken even at a preterm gestation. With proning and consequently improved oxygenation, iatrogenic preterm delivery might be avoided.
The purpose of this manuscript is to demonstrate a proning technique that was successfully used at our institution to avoid premature delivery of the fetus while improving maternal outcomes. All technical challenges are addressed in an instructional Video 1 and 2 with a pregnant model with twin gestation at 32 weeks.