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Prevention is better than treatment and vaccination is safe at all stages of pregnancy and whilst breastfeeding. 98% of severe Covid‐19 infections in pregnant women admitted to hospital were in unvaccinated women.

At the time of writing, detailed evidence‐based treatment guidance is being regularly updated on the Royal College of Obstetricians and Gynaecologists website (rcog.org.uk).

Initial management of Covid‐19 in pregnancy:

 Oxygen – titrate supplemental oxygen to keep SaO2 >94%

 Thromboprophylaxis – prophylactic LMWH dose by weight for at least 10 days

 Corticosteroids – if oxygen dependent give for a total of 10 days or until discharge (oral prednisolone 40 mg OD or IV, hydrocortisone 80 mg BD)

 If steroids are required for fetal lung maturation use dexamethasone 12 mg IM for two doses followed by either of the above corticosteroids for 10 days

 Give tociluzimab (or sarilumab if unavailable) if hypoxic (oxygen requirement) and C‐reactive protein >75

 If SARS‐CoV‐2 antibody negative and non‐Omicron variant (anti‐spike protein testing), consider 2.4 g Ronapreve® IV

 Chest imaging is essential for evaluation of the unwell pregnant woman with Covid‐19 and should be performed if indicated

 Careful fluid balance

Clinical deterioration (increasing oxygen requirements, SaO₂ <93%, respiratory rate >22):

 Convene the MDT to consider the site and location of care, including an obstetrician, anaesthetist, neonatologist, intensivist and infectious disease physician

 Consider admission to critical care for respiratory support (invasive or non‐invasive), proning and early discussion with ECMO centre