1. Blood, birthing and body fluids:
Kailahun, 2014
°BBC, 2014
Blood, birthing and body fluids:
Delivering and staying alive in an Ebola Management Centre
Séverine Caluwaerts, Daphne Lagrou, Patricia Lledo Weber, Benjamin Black, Tom Decroo,
Alseny Modet Camara, Michel Van Herp

2. 1. Introduction 2014/2015 West-Africa Ebola epidemic
How to care for Ebola-infected pregnant patients?
What are the implications of pregnant Ebola survivors?
Limited data in literature:
1976: 9/82 (11%) maternal survivors
Foetal/neonatal mortality 100%
Lack of adequate guidelines
Medical staff anxious when caring for pregnant Ebola patients
Blood birthing and body fluids Séverine Caluwaerts

3. Introduction AIM of the research:
Describe specific adapted management protocol for caring for pregnant Ebola virus disease (EVD) patients
Describe the characteristics of pregnant/postpartum EVD survivors and neonates
Blood birthing and body fluids Séverine Caluwaerts

4. Methods
Teams in MSF Ebola Management Centres (EMCs) were contacted and asked to report on pregnant Ebola patients
8 study sites reported (Guéckédou, Donka, Freetown, Kissy, Bo, Kailahun, Foya, Monrovia) from 1/04/2014 until 25/04/2015
This retrospective descriptive analysis met the MSF Ethics Review Board criteria for exemption from ethics review
Blood birthing and body fluids Séverine Caluwaerts

5. Results - management protocol
Meanwhile 4 updates -initially main emphasis on protection of health care workers (HCW): no invasive procedures, no suturing, strict waste management protocols -preference for oral drugs (misoprostol instead of oxytocin for prevention of postpartum haemorrhage) -later possibility of life-saving blood transfusion (3 patients transfused), MgSO4 treatment (1 patient treated) -importance of family planning/condom use
Blood birthing and body fluids Séverine Caluwaerts

6. Results - pregnant survivors
33 pregnant survivors in MSF EMCs
9 (27%) in first trimester (probably underreporting,
initially no systematic pregnancy testing at admission)
(2 first trimester patients arrived already blood PCR negative)
15 (45%) in second
9 (27%) in third trimester
Median age: 22 years [range 16-35]
Sierra Leone
Sept 2014
°Ruth Kauffman, 2014
Blood birthing and body fluids Séverine Caluwaerts

7. Results - foetuses
33/34 (97%) stillbirths/miscarriages (1 pregnancy was twin pregnancy)
One baby born alive (Guéckédou, Guinea)
good Apgars,
lived 2 days
°BBC, 2014
Blood birthing and body fluids Séverine Caluwaerts

8. Results: PCR from 15 deliveriesPt
Site
Month admission
Pregn. Trim.
Days between blood negativation and delivery
Sample from
PCR : CT values (+;++;+++) 1
Guéck
June 14
3rd 4
Amniotic fluid
21,41 (+++) 2
24,10 (+++) 3
Oct 14
2nd 32
22,29 (+++)
(+++) 5
Donka
Nov 14
Placenta (mat) 6
Dec 2014 9
Placenta/amniotic fluid
25 (+++), 28 (++) 7
Jan 15
(++) 8
Kailahun
Sept 14 10
23 (+++)
Buccal swab
21 (+++)
22 (+++) 11
Kissy
21,3 (+++) 12
Feb 15
1rst
4 (blood PCR neg at entrance)
Miscarriage
16 (+++) 13
April 15 31
Placenta
19,2 (+++) 14
Freetown
24 (+++) 15
Foya
July 14
Foetus
‘positive’
15/15 +ve
13/15 CT <25 (+++)

9. Conclusion Limitations: no systematic data-collection
Pregnant woman can survive Ebola
Need for pregnancy tests at admission
Adapt management and monitoring
Foetal/neonatal mortality 100%
No HCW infections registered when caring for pregnant Ebola patients
PCR amniotic fluid highly positive up to 32 days after negativation of the blood of the mother
Pregnant survivor possibly infective after cure
Urgent need for viral culture!
=> Every pregnant Ebola survivor needs to deliver in an EMC
Blood birthing and body fluids Séverine Caluwaerts

10. Thanks to
Everyone who reported data and cared for the patients (Floribert Lomboto , Furaha Walumpumpu, Maya Vergara, Ruth Kauffman, Benjamin Black, Patricia Lledo, Nelly Staderini ,Michel Moreau, Modet Camara, Maud Santantonio, Axelle Ronsse, Aicha Taybi, Jeff Edwards, Lucie, Fernanda Baggi and many more) and the field teams from Liberia, Guinea and Sierra Leone
Luxor operational research unit
Blood birthing and body fluids Séverine Caluwaerts
°MSF, 2014