SARS-CoV-2 infection in very preterm pregnancy: Experiences from two cases Dear Editor, We present our experience of managing two cases of SARS-CoV-2 infection in very preterm pregnancy. A 39 year-old primigravida presented with 5 days of dyspnoea, cough and pyrexia at 28 + 4 weeks of gestation. She was Afro-Caribbean, had BMI 42 and type 2 diabetes mellitus. Her respiratory rate was 20 breaths/minute, oxygen saturations (SpO2) 92 % and arterial partial pressure of oxygen (PaO2) was 8.1 mmHg in air. Chest X-ray showed bilateral infiltrates (Fig. 1). SARS-CoV-2 infection causing type 1 respiratory failure was presumed. She received corticosteroids for fetal maturation. After 24 h she deteriorated and was admitted to ICU for high-flow nasal oxygen and then noninvasive ventilation 3 h later. A multidisciplinary (obstetric, anaesthetic and intensivist) decision was made for delivery by caesarean section, to facilitate invasive ventilation of the woman. This followed magnesium sulphate for fetal neuroprotection. Maternal airway pressures and oxygen requirements were high throughout surgery. After surgery she was positioned flat for central venous cannulation and deteriorated acutely post-procedure, with high airway pressures and SpO2 of 35 % despite fractional inspired oxygen (FiO2) of 1.0. Needle chest decompression was performed to exclude iatrogenic tension pneumothorax, although no gas escape was heard, and subsequent ultrasound excluded pneumothorax. Endotracheal tube position was confirmed, air entry was bilateral.
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