Challenges in maintaining oxygen saturation in pregnant individuals residing in low and middle-income countries: a response.

We thank the authors for the thoughtful letter in reply to our publication.1Eid J. Stahl D. Costantine M.M. Rood K.M. Oxygen saturation in pregnant individuals with COVID-19: time for re-appraisal?.Am J Obstet Gynecol. 2022; 226: 813-816Abstract Full Text Full Text PDF Scopus (0) Google Scholar We agree that anemia and other comorbidities such as preexisting vascular disease should be considered when selecting an oxygen saturation target that balances maternal-fetal well-being and the risks of medical intervention. However, we disagree with the authors regarding the assertion that pregnant individuals with moderate or severe COVID-19 require a 94% to 95% oxygen saturation in the absence of comorbidities. There is still no objective evidence in the literature supporting this higher oxygen saturation goal. As we described earlier, all previous acute respiratory distress syndrome data and generalizing these data to a population of pregnant individuals who are by and large healthy would suggest that lower levels of oxygen would be well tolerated, and this would decrease the risk of unnecessary medical intervention. In our publication, we proposed the use of external fetal monitoring as an indicator of fetal well-being, mainly when the decision to escalate toward invasive measures is based on the concern for maintaining fetal oxygenation rather than the mother’s respiratory status.1Eid J. Stahl D. Costantine M.M. Rood K.M. Oxygen saturation in pregnant individuals with COVID-19: time for re-appraisal?.Am J Obstet Gynecol. 2022; 226: 813-816Abstract Full Text Full Text PDF Scopus (0) Google Scholar We agree with the authors regarding the false positives associated with it. However, having a reassuring fetal heart rate is associated with adequate oxygenation and perfusion of the fetus.2Skupski D.W. Rosenberg C.R. Eglinton G.S. Intrapartum fetal stimulation tests: a meta-analysis.Obstet Gynecol. 2002; 99: 129-134Crossref PubMed Scopus (73) Google Scholar When used in this setting, it can help prevent unnecessary invasive interventions such as endotracheal intubation. We look forward to peer-reviewed evidence from the PregCovid and other registries that may continue to inform our understanding. Oxygen saturation in pregnant women with COVID-19: challenges in low-income and middle-income countriesAmerican Journal of Obstetrics & GynecologyPreviewWe read the interesting article titled “Oxygen saturation in pregnant individuals with COVID-19: time for re-appraisal?”1 We agree with the authors that inpatient monitoring should be considered for pregnant individuals with moderate or severe COVID-19. Eid et al1 proposed maternal O2 saturation (SpO2) levels between 92% and 96% for admitted patients with acute respiratory failure who require supplemental O2. However, based on our experience of the PregCovid registry,2 we suggest a single cutoff level of either 94% or 95%. Full-Text PDF