Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome.

Prone positioning (PP) improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Data regarding feasibility and effectiveness of PP in pregnancy are lacking. This subgroup analysis of a cohort study that included mechanically ventilated pregnant women presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who underwent PP aims to assess the efficacy and safety of PP. Ventilatory and gasometric parameters were evaluated at baseline (T 0 ) and in prone (T 1 ) and supine (T 2 ) positions. Obstetric outcomes were also assessed. Sixteen cases at an average of 27.0 (22.0-31.1) gestational weeks of pregnancy were included. Obesity and hypertension were frequent comorbidities. PP was associated with a >20% increase in PaO 2 levels and in PaO 2 /FiO 2 ratios in 50% and 100% of cases, respectively. The PaO 2 /FiO 2 ratio increased 76.7% (20.5-292.4%) at T 1 and 76.9% (0-182.7%) at T 2 . PP produced sustained improvements in mean PaO 2 /FiO 2 ratio ( p < 0.001) and PaCO 2 level ( p = 0.028). There were no cases of emergency delivery or suspected fetal distress in pregnancies ≥25 weeks during the 24 h period following PP. PP is safe and feasible during pregnancy, improving PaO 2 /FiO 2 ratios and helping to delay preterm delivery in severe ARDS.