Use of the prone position in pregnant women with COVID-19 or other health conditions

Abstract

Objective: to analyze, in the scientific literature, the knowledge available on the use of the prone position in pregnant women diagnosed with COVID-19 or other health conditions. Method: an integrative literature review developed through the following guiding question: What is the scientific knowledge available on the use of the prone position in pregnant women with COVID-19 or other health conditions? The search for studies was carried out in eight databases. Results: using the prone position in pregnant women with Acute Respiratory Distress syndrome allowed for improvements in lung compliance and oxygenation. It also allowed reducing uterine compression on the maternal large vessels, and a reduction in blood pressure was observed in pregnant women with pre-eclampsia. The prone position was also safe in the surgical management of pregnant patients. In addition, the following conditions stood out as disadvantages related to the prone position in pregnant women: possibility of aortocaval compression, causing severe hypotension, and inability to easily monitor fetal status or to perform emergency Cesarean sections. Conclusion: the prone position was considered safe, reliable and comfortable for its use in the clinical management of pregnant women, where specific care measures must be taken to avoid compression of gravid abdomen, as well as fetal monitoring is important to detect placental circulation impairment.

Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID-19 Patient With Control Cesarean Section

“…In ARDS using mechanical ventilation with a high PEEP, low tidal volume and allowing low plateau pressure with permissive hypercapnia, paralytics use for synchrony with the ventilator along with proning remain the cornerstones of therapy. Prone ventilation has been used during pregnancy and reported in the case report series [ 11 ]. Proning provides an augmented ventilation-perfusion ratio while decreasing the compression of the posterior and medial lung, causing a decrease in hypoxic vasoconstriction, an improvement in cardiac output, and recruitment of more alveolar units.…”

Surgical treatment of adrenal tumors during pregnancy

“…[80] This approach may be advantageous in the gravid patient as the modified prone positioning of the patient for this technique alleviates compression of the uterus on the vena cava and is associated with improvements in oxygenation and systolic blood pressure. [66,70,71,81] However, this benefit must be balanced with the higher insufflation pressures that are required for adequate exposure (20-28mmHg), which effectively compresses the IVC. These insufflation pressures have been shown to be safe without significant hemodynamic effects in the general population undergoing right-sided PRA.…”

“…Recent use of prone positioning in pregnant patients with COVID-19 pneumonia and acute respiratory distress has demonstrated that this positioning is safe, though continuous fetal monitoring is advised. [66,70,71].…”

Acute Respiratory Distress Syndrome in Pregnancy: Updates in Principles and Practice

“…However, in pregnant patients with moderate to severe ARDS prone positioning has been reported to be safe and effective. [83][84][85][86][87] In addition, the ELSO-based registry reported 58% of pregnant and peripartum patients were prone positioned before ECMO initiation. 81 Modification of prone positioning, especially in patients in the third trimester (24 to 28 wk), involves use of padding or blankets and pillows above and below the gravid uterus to avoid aortocaval compression.…”

“…In nonpregnant patients with ARDS, prone positioning is an effective salvage therapy82 and before the 2019 COVID pandemic, prone positioning was infrequently used in pregnant patients. However, in pregnant patients with moderate to severe ARDS prone positioning has been reported to be safe and effective 83–87. In addition, the ELSO-based registry reported 58% of pregnant and peripartum patients were prone positioned before ECMO initiation 81.…”