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AFLP and PPCM are rare complications of pregnancy. We present a patient who had both. Both diseases carry a high mortality rate, and together, are likely fatal.

The novel coronavirus disease 2019 pandemic is an incredibly dynamic and rapidly evolving global health emergency. Protocols and procedures for clinical care management are evolving and require refinement as information continues to become available about the nature and breadth of the disease. With no clinical trials to guide practice, familiarity with the most recent recommendations from the experts in the field will assist in implementing the best possible treatment decisions for patients. To date, there is limited information from published scientific reports about the susceptibility and severity of COVID-19 infection in pregnant women. Avail-able data in pregnancy are reassuring in regard to vertical transmission and maternal severe morbidities and mortality but are limited to small case series. While the reported series have included women who underwent cesarean delivery, the mode of delivery should be dictated by usual obstetric practice. 1,2 Cesarean delivery is the most common surgical procedure in the United States and hence, it is essential that protocols to be developed for women with confirmed or suspected COVID-19 infections who require cesarean delivery. In this paper, we describe a protocol we developed for our labor and delivery (L&D) unit. AbstractWe sought to provide a clinical practice protocol for our labor and delivery (L&D) unit, to care for confirmed or suspected COVID-19 patients requiring cesarean delivery. A multidisciplinary team approach guidance was designed to simplify and streamline the flow and care of patient with confirmed or suspected COVID-19 requiring cesarean delivery. A protocol was designed to improve staff readiness, minimize risks, and streamline care processes. This is a suggested protocol which may not be applicable to all health care settings but can be adapted to local resources and limitations of individual L&D units. Guidance and information are changing rapidly; therefore, we recommend continuing to update the protocol as needed.

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