Ebola and Pregnant Women: Providing Maternity Care at MSF Treatment Centers

Abstract

Caring for Ebola-positive patients is complex, but caring for Ebola-positive pregnant patients during the 2014–2016 West-Africa epidemic was an even more complicated challenge for Médecins Sans Frontières (MSF) and other frontline responders. Very little data had been published on Ebola and pregnancy, and the few reports available at the start of the outbreak suggested mortality of 90–95% for mothers and 100% for fetuses/neonates. Initially, medical teams were severely hampered by the lack of knowledge and clinical guidance on managing pregnant patients, which was seen essentially as providing palliative care for mother and fetus. In early August 2014 (6 months into the outbreak), MSF published the first such guidelines, adapted to the realities of the West Africa setting, followed by four updates during the remainder of the epidemic. With more experience and clear guidelines for improved care, MSF saw that mothers had a reasonable chance of survival—36 out of 77 documented pregnant patients (47%) survived this epidemic. Additionally, the first documented survivor of transplacental Ebola was reported in Guinea in October 2015. Many questions still remain, but the new knowledge, data, and field-tested guidelines that emerged from this outbreak can help inform care of pregnant women in future outbreaks. MSF data have been shared with the worldwide scientific community, via medical journals and online publication.

All names have been changed to protect patient privacy. The exception is the infant Nubia, whose remarkable survival was widely reported in the media in late 2015, with her father’s consent.