Viral pneumonia occurring during pregnancy is associated with increased morbidity and mortality. Pregnant women are more susceptible to respiratory pathogens because of the pregnancy-related physiological changes. Pregnancy does not seem to aggravate the course of symptoms and clinical characteristics of COVID-19 pneumonia, and the first reports on COVID-19 epidemiology data show an approximately superimposable rate of intensive care unit (ICU) hospitalization. However, optimal management in severe COVID-19 related pneumonia during pregnancy is still debated. After obtaining written informed consent and the ethics committee approval (Comitato Etico Interaziendale, Cuneo, Italy), we report the case of a 28-week pregnant woman with COVID-19 related ARDS.