Ebola viral disease and pregnancy

Abstract

Ebola viral disease’s interaction with pregnancy is poorly understood and remains a particular challenge for medical and para-medical personnel responding to an outbreak. This review article is written with the benefit of hindsight and experience from the largest recorded Ebola outbreak in history. We have provided a broad overview of the issues that arise for pregnant women and for the professionals treating them during an Ebola outbreak. The discussion focuses on the specifics of Ebola infection in pregnancy and possible management strategies, including the delivery of an infected woman. We have also discussed the wider challenges posed to pregnant women and their carers during an epidemic, including the identification of suspected Ebola-infected pregnant women and the impact of the disease on pre-existing health services. This paper outlines current practices in the field, as well as highlighting the gaps in our knowledge and the paramount need to protect the health-care workers directly involved in the management of pregnant women.

Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States

“…Although we did not detect EBOV RNA in this patient during pregnancy, women who are pregnant during acute EBOV infection usually transmit virus to the fetus and may pose an infectious risk to healthcare providers and others during delivery or abortion ( 3 ). EBOV can readily cross the placenta, and pathologic examination of placental tissues of patients with confirmed EVD have demonstrated EBOV antigen in the trophoblasts, syncytiotrophoblasts, and circulating maternal macrophages ( 4 ).…”

“…The immune effects of pregnancy in the context of EVD have not been well documented ( 3 ); however, alterations in the immune system do occur during pregnancy ( 31 ), which during acute EBOV infection likely increases the risk for a poor outcome, including spontaneous abortion and neonatal death. Unlike the CNS, eye, and male testis, the genital tract of a nongravid female is not traditionally considered an immune-privileged site ( 32 – 34 ).…”

Optimal Conditions for the Control of Ebola Viral Disease

“…First one is related to the pregnancy which has not been yet studied in details and is still a challenge to the authorities dealing with the responding teams of the outbreak. For further details we refer the reader to [21]. The other implication is early transmission of Ebola virus.…”

Recent advances on Ebola virus

“…It has been hypothesized that persistence of Ebola virus in immune-privileged sites such as brain and retina may affect the developing fetus [8]. Male survivors had shown to shed Ebola virus with ribonucleic acid in semen for at least 18 months after onset of EVD [9].…”