The coronavirus disease 2019 (COVID-19) pandemic has prompted expanded use of prone positioning for refractory hypoxemia. Clinical trials have demonstrated beneficial effects of early prone positioning for acute respiratory distress syndrome (ARDS), including decreased mortality. However, pregnant women were excluded from these trials. To address the need for low-cost, low-harm interventions in the face of a widespread viral syndrome wherein hypoxemia predominates, we developed an algorithm for prone positioning of both intubated and nonintubated pregnant women. This algorithm may be appropriate for a wide spectrum of hypoxemia severity among pregnant women. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the clinical manifestations of COVID-19. This syndrome can manifest as severe pneumonia complicated by hypoxemia and ARDS. Given the current global COVID-19 pandemic, with a large number of ARDS cases, there is renewed interest in the use of prone positioning to improve oxygenation in moderate or severe hypoxemia. Among the populations who can benefit from prone positioning are pregnant women experiencing severe respiratory distress, as long as the physiologic changes and risks of pregnancy are taken into account.

(Obstet Gynecol. 2020;136:259–261) In pregnant patients undergoing ventilation, the goal is to achieve relative hypocapnia while also protecting the lungs by maintaining a safe tidal volume and plateau pressures. Mild hypercapnia (partial pressure of carbon dioxide 50 to 60 mm Hg) may be acceptable if needed to protect the lungs. When using strategies with high-positive end-expiratory pressure require continuous monitoring of mother and fetus.

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An obstetric rapid response team (RRT) should ideally include the readily available presence of an obstetrician and a well-established system for escalation of care and management of the fetus where applicable. During the evaluation of an obstetric patient, the RRT team should be familiar with the unique changes in maternal pregnant physiology and their influence on the presentation and management of common maternal emergencies. Postpartum hemorrhage, pre-eclampsia related complications, and sepsis together form the bulk of causes for maternal RRT calls. The knowledge of, and competence with, left lateral displacement of the uterus and the timing and execution of perimortem cesarean section are essential during maternal cardiopulmonary resuscitation. In this chapter, we review common maternal emergencies during RRT activation and their management.

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