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Ebola and Pregnancy

General pregnancy guidance:


Ebola viral infection is associated with high maternal mortality and near-universal neonatal mortality rates in resource-limited settings (e.g. West Africa). Evidence-based clinical guidelines for high-resource settings, such as the U.S., are difficult to develop given the absence of data generated from these health care environments. Furthermore, as experience is gained in the U.S. treating these patients, regionalization of this specialized care may continue to evolve. In the meantime, MFM specialists may serve as resources to develop local guidance for pregnant women. While SMFM, ACOG and CDC cannot provide specific obstetric direction, general guidance on identification, isolation and initial management of pregnant women, useful to most obstetrical units, has already been provided.

To see other general guidance documents please click here

To view CDC's guidance on caring for pregnant women with Ebola, please click here.

To view ACOG's Ebola page please click here.


Protocols

Obstetrical care of women with Ebola infection is particularly concerning due to the high likelihood of exposure to copious blood and body fluids, all of which are highly contagious. Thus, decisions regarding obstetric interventions must be weighed in the context of the severity of maternal illness, likelihood of actual Ebola infection, availability of maximal personal protective equipment (PPE) for trained personnel and risk to the caregiver. Obstetric interventions in the context of three broad categories of women should be considered, recognizing that the majority of women with symptoms and exposure to Ebola infection will have other diseases such as influenza and malaria and should be managed accordingly. A much smaller group will fit into one of the following potential maternal presentations:

  1. Maternal late Ebola illness, decompensated state with multi-organ failure. Mortality in this stage of Ebola illness is very high. Severe hemorrhage is common.
  2. Maternal early Ebola illness. Fever and constitutional symptoms are present. Supportive care is the focus. 
  3. Maternal person under investigation (PUI). This is a person with an epidemiologic risk factor for exposure to Ebola virus as well as symptoms that could be consistent with Ebola disease, but other causes of illness may also be etiologic factors. Some of these women will be found to have Ebola infection while most will not. All, however, should be treated as if they are infected until the results of PCR testing are available.

The approach and management of each of the above scenarios will differ and must be individualized. Institution-specific protocols developed by MFM specialists at various institutions around the country are provided and may be useful as MFM specialists think through these scenarios in their own institutions.

To view Sample Protocols for Case Identification/Triage and Initial or Unplanned Management click here and click here and here

To view Sample Protocols for Centers Designed to Receive and Manage Cases Including Those Identified by Others click here and here


Resources for Consultation on Ebola in pregnancy

Planned approaches to the care of pregnant patients with suspected or confirmed cases of Ebola vary across the country, with current activity on both institutional and regional fronts. Inasmuch as data to guide management of such patients in well-resourced settings are sparse, case-by-case, specific conversations between providers “on the ground” and local, regional or national authorities may prove invaluable. SMFM has compiled a list of U.S. specialists willing to be contacted to participate in informal discussions about patient management should concerning cases present. Please consider contacting one of these resources, particularly those in your region, if the need arises.

To view a list of contacts around the country that are participating in Ebola preparedness in pregnancy please click here


Advocacy

As we struggle domestically to establish Ebola preparedness within our own institutions, we are increasingly aware of the plight of our African colleagues who are facing the worst outbreak of Ebola in history.  Please consider contributing to one of the many well established organizations (we've included several below) in helping to fight Ebola in West Africa.  For those considering volunteering in West Africa, additional useful information can be found in the Volunteering section under Donations.  

Donations
Surveillance and Public Health Response
1)    CDC Foundation
2)    International Rescue Committee
Medical Care
1)    Medicins Sans Frontiers (Doctors without Borders)
2)    International Federation of Red Cross and Red Crescent
3)    International Medical Corps
Maternal Child Health
1)    UNICEF
2)    Save the Children
3)    UNFPA
Food
1)    World Vision
2)    World Food Program

Volunteering
The CDC is offering a training course for healthcare workers going to West Africa in response to the Ebola Outbreak.  Details can be found here

Several additional websites for those considering volunteering:
-    Advice to Humanitarian Workers Traveling to West Africa for the Ebola Outbreak
-    Ebola Medical Volunteer Inquiry Form
-    Nongovernmental organizations responding to Ebola





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