COVID-19 in pregnancy

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 5 – A N T E N ATA L C A R E

COVID-19 in Pregnancy Greer O, Saeed Z, Woon EV et al. COVID-19 in pregnancy. TOG 2025;27:43–56. doi:10.1111/tog.12960

2.64/100,000 83% 94–98% UK COVID-19 CASE FATALITY RATE PER MRNA VACCINE EFFECTIVENESS VS TARGET OXYGEN SATURATIONS (RCOG) MATERNITIES HOSPITALISATION

DO N' T-M IS S FA C TS

  1. Escalate: oxygen requirement, RR ≥20/min or HR ≥110 bpm → urgent MDT (RCOG). Target sats 94–98%

  2. Urgent critical care review: RR ≥25 despite O₂, FiO₂ >35%, ↓urine output, creatinine >77 µmol/L, altered mentation

  3. Antenatal steroid = unfluorinated (prednisolone/methylprednisolone/hydrocortisone; ~10% reaches fetus). Dexamethasone only if preterm delivery imminent

  4. Sotrovimab within 5 days of symptom onset (RRR 85%); tocilizumab/sarilumab if hypoxic; remdesivir by MDT decision if deteriorating

  5. Give prophylactic LMWH to all pregnant women admitted or severely ill with COVID-19

  6. Prone up to at least 28 weeks; beyond that use left lateral decubitus (WHO/RCOG)

  7. Pregnancy is not a contraindication to ECMO – refer early if deteriorating (maternal survival 77.2%)

  8. Only mRNA vaccines licensed in UK pregnancy; effectiveness 83%; ideally >9 days before birth for neonatal antibody transfer. Breastfeeding recommended

KEY OUTCOME ODDS RATIOS (ALLOTEY ET AL.)

ICU admission OR 2.61 Invasive ventilation OR 2.41 Death OR 6.09 Preterm birth OR 1.57 Caesarean OR 1.17

Stillbirth OR 1.81 Neonatal death OR 2.35 No ↑ miscarriage <24 weeks Vertical transmission 0.9–2.8%

ABBREVIATION KEY

ACE-2 — angiotensin-converting enzyme 2 ASC — antibody-secreting cell

TMPRSS2 — transmembrane serine protease 2 NP — nucleocapsid protein

RAS/RAA — renin–angiotensin–aldosterone system LMIC — low- and middle-income country

VoC — variant of concern LMWH — low molecular weight heparin

MBRRACE — Mothers and Babies: Reducing Risk through Audits UKTIS — UK Teratology Information Service and Confidential Enquiries FGR — fetal growth restriction ECMO — extracorporeal membrane oxygenation FiO₂/PaO₂ — inspired O₂ fraction / arterial O₂ pressure cTFH — circulating T follicular helper cells

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Greer O, Saeed Z, Woon EV et al. COVID-19 in pregnancy. TOG 2025;27:43–56. doi:10.1111/tog.12960

Clinically reviewed by NHS obstetricians and gynaecologists

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