Biomedical Engineering Reference
In-Depth Information
Lassa, and Congo-Crimean. Ebola infection is
generally more serious during pregnancy with
higher hemorrhagic and neurologic complications.
It is also associated with a higher mortality (95%
vs. 77% in non-pregnant victims). Mortality does
not, however, differ between trimesters. The risk
for spontaneous abortion appears to be higher in
infected women. Treatment of Ebola in pregnancy
is supportive care and correction of the hema-
tologic abnormalities. Lassa Fever also has an
increased mortality during pregnancy and this risk
is highest during the third trimester. Ribavirin may
decrease the fatality rate although it is a Category
X medication. It has been suggested that delivery
may improve maternal outcome in the setting of
Lassa Fever.
If an obstetric or surgical procedure is indicated
in a patient infected with VHF, the state health
department and CDC should be consulted with
regard to appropriate precautions during the perfor-
mance of these procedures.
direct fetal infection.
Coxiella
has been detected
in both the placenta and fetal viscera of infected
pregnancies. Infection in animals may be spread at
the time of delivery via aerosol from an infected
placenta and infection of an obstetrician following
an infected woman has been reported.
Concurrent use of doxycycline and chloro-
quine is the only effective in vitro bacteriocidal
regimen although concerns have been expressed
with regard to long term use of doxycycline
during pregnancy. Treatment with trimethoprim-
sulfamethoxazole (TMP-SMX; 160mg trimetho-
prim and 800mg sulfamethoxazole p.o. bid) has
been shown to be effective in reducing the compli-
cations associated with Q fever during pregnancy.
The development of chronic infection is not,
however, prevented by TMP-SMX. A one year
course of doxycycline and chloroquine following
delivery is therefore recommended.
Coxiella
has
been isolated from human breast milk and thus
breastfeeding is contraindicated for woman with Q
fever. Women with acute infection prior to preg-
nancy do not appear to be at increased risk for
adverse obstetric outcomes.
12.3.2 Category B Biologic Agents
12.3.2.1 Q fever
Q fever is caused by
Coxiella burnetii
. Chronic
infection develops only in patients with a compro-
mised immune system; pregnant women are among
those at particular risk for chronic infection.
Bacteria colonize and replicate in the placenta,
uterus, and mammary glands when a woman
is infected during pregnancy. The data suggest
women with primary infection during pregnancy
are at increased risk for abortion, premature
delivery and in utero fetal demise, depending upon
the timing of infection. The pathogenesis of fetal
disease may be related to placental vasculitis and/or
12.3.2.2 Brucellosis
Brucellosis infection in pregnancy poses a substan-
tial risk for spontaneous abortion with the highest
risk in the first and second trimesters. Congenital
brucellosis has been reported although transpla-
cental transmission has not been well-documented.
Rifampin 900mg p.o. qd for 6 weeks has been
recommended as the primary treatment for preg-
nant women with brucellosis. Alternatively, TMP-
SMX or TMP-SMX plus rifampin have been used
with evidence of a decreased rate of spontaneous
abortion.
