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

Francisco Marcelo Leandro Cavalcante,Nelson Miguel Galindo-Neto,Lívia Moreira Barros,Joselany Áfio Caetano,Cristina Da Silva Fernandes,Luanna Dos Santos Rocha

doi:10.1590/1518-8345.5181.3494

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.

Highlights

SARS-CoV-2 had its first cases in Wuhan, China, where in late December 2019 a number of pneumonia cases caused by unknown etiologic agents were reported to the World Health Organization (WHO)
Since notification of the first COVID-19 cases in the American Continent, more than 60,000 confirmed cases of the disease were identified among pregnant women, including 458 maternal deaths according to the Pan American Health Organization (PAHO), with more than half occurring in Brazil and Mexico[2]
There was a reduction in diastolic blood pressure in the prone position, both in the healthy pregnant women (p‡=0.064) and in those with pre-eclampsia (p‡=0.019); there was increased maternal heart rate in the prone position when compared to the left lateral position, with statistical significance

Summary

Introduction

SARS-CoV-2 had its first cases in Wuhan, China, where in late December 2019 a number of pneumonia cases caused by unknown etiologic agents were reported to the World Health Organization (WHO). Since notification of the first COVID-19 cases in the American Continent, more than 60,000 confirmed cases of the disease were identified among pregnant women, including 458 maternal deaths according to the Pan American Health Organization (PAHO), with more than half occurring in Brazil and Mexico[2]. Until December 16th, 2020, the Brazilian Ministry of Health recorded 4,564 hospitalization cases due to ARDS and 233 deaths among pregnant women with confirmed COVID-19 cases in the country, indicating a mortality rate of 86.2 deaths/100,000 inhabitants in this population[3]. The high morbidity and mortality rate due to COVID-19 among Brazilian pregnant women can be related both to pathophysiological conditions inherent to the process of pregnancy and illness caused by infection with SARS-CoV-2, and to the chronic problems faced by Brazilian obstetric care – such as low quality and difficulty accessing emergency and high-complexity care[4]. It is understood that the assistance provided to pregnant women affected by the disease requires special care measures, in an attempt to preserve the best obstetric practices and to achieve positive maternal and fetal outcomes[5]

Methods

Results

Discussion

Conclusion