Reply to LUS in pregnant women with suspected COVID-19 infection.

To the Editor: We greatly thank Dr Gil‐Rodrigo and colleagues for the letter reporting their experience in treating pregnant patients. The authors have shared their experiences to support and highlight the use of LUS during the COVID‐19 pandemic. In this particular context, LUS can be a useful tool for pregnant women admitted to the emergency department for flulike symptoms with fever, dry cough, and dyspnea.

Women should immediately receive LUS to define subsequent management paths. Normally, pregnant women should have a normal LUS pattern because it is conceivable that they have a good basic health status and no previous lung diseases, except for a few rare cases.

Sometimes, at the most advanced gestational ages, it is possible to identify slight posterior bilateral basal sonographic interstitial syndrome because of the increase in the size of the abdomen and the accumulation of fluids. Therefore, in a symptomatic context compatible with COVID‐19, if LUS findings are suggestive of patchy bilateral pneumogenic sonographic interstitial syndrome, patients must be kept in isolation waiting for the results of microbiological tests. These LUS findings are highly suggestive of COVID‐19 pneumonia, although not definitively specific. , ,

Indeed, LUS‐suggestive findings could even foster therapeutic decisions, as already described by the authors, for some cases as well as reported in a previous published work from our group. Lung US also has the advantage of being able to be performed as an extension of an obstetric echographic evaluation at the same time and by the same operator to reduce exposure to contamination.

Short educational programs should be performed to train physicians, to standardize acquisition protocols, and to recognize US patterns in patients with symptoms compatible with viral pneumonia. For that specific aim, a “fast lung US teaching program” dealing with pregnant women with suspicion of COVID‐19 infection has been proposed and developed for gynecologists and obstetricians, specialists usually with long‐time experience as sonographers.

Finally, in the general context of LUS, a very interesting experience about the use of contrast‐enhanced LUS for the characterization of subpleural consolidations in patients with COVID‐19 has recently been reported. This experience demonstrated that, at least in part, some consolidations have been caused by perfusion defects and ischemic phenomena and not only by atelectasis and inflammation. This evidence supports the ever‐grooving key role of thromboembolic disorders in cases of COVID‐19 pneumonia with severe respiratory failure.

To conclude, as had reported a few years ago, highlighting for the first time the advantages of LUS in pregnant women, why not also take a look at the chest in these patients?