Ebola in Pregnant Women: Clinical Guidance for U.S. Hospitals

For healthcare providers in U.S. hospital emergency departments and labour and delivery units.

This CDC guidance covers screening pregnant women for Ebola virus disease (EVD), caring for pregnant women who are patients under investigation (PUIs) for EVD or have confirmed EVD, and considerations for pregnant healthcare workers. It is meant to help U.S. hospitals plan for screening and treating these patients.

Recommendations

• Providers caring for pregnant women in U.S. hospitals should be ready to screen for EVD, with a plan in place to triage these patients.
• Obstetric decisions for women with EVD, above all the mode of delivery during labour, must weigh the risks to the woman, the risk of exposure for healthcare workers, and the possible benefits to the newborn.
• Pregnant healthcare workers should not care for patients with EVD.
• Pregnant PUIs and patients with confirmed EVD should be admitted to hospital and cared for under CDC's guidance for hospitalised PUIs and patients with EVD.

What is known about EVD in pregnancy

• Susceptibility. There is no evidence that pregnant women are more likely than others to be infected with Ebola virus.
• Severity. Earlier reports suggested pregnant women faced a higher risk of severe illness and death; more recent reviews suggest pregnancy does not raise mortality or disease severity.
• Pregnancy outcomes. Pregnant women with EVD are at higher risk of adverse outcomes, including fetal loss and pregnancy-related haemorrhage. In past outbreaks in Africa, almost no infants born to people with EVD survived, though Ebola was not always known to be the cause of death.
• Transmission to the fetus. Ebola virus can cross the placenta, and an infected pregnant woman will probably pass it to the fetus. Pathology has found Ebola antigen in many types of placental cell, and Ebola RNA has been found in amniotic fluid, placental tissue, fetal meconium, vaginal secretions, umbilical cord, and cheek swabs from newborns.
• After recovery. Ebola RNA can stay detectable in amniotic fluid, breast milk and fetal tissue after the mother recovers; it has been found in pregnancy-related fluids and tissues up to 32 days after the virus cleared from her blood. Proper infection-control precautions should therefore be taken with pregnant women who are convalescing.

Sources

• Centers for Disease Control and Prevention, "Clinical Guidance for Ebola in Pregnant Women." https://www.cdc.gov/ebola/hcp/clinical-guidance/clinical-guidance-for-ebola-in-pregnant-women.html