Ebola virus disease in pregnancy and anesthetic considerations

Ebola virus disease (EVD) is often lethal, mortality rates range from 50% to over 90%, depending on the patient population, viral strain, and access to medical care. During pregnancy, the morbidity and mortality from the viral disease has been suggested to be among the highest of any affected patient population. According to the existing literature, which is confined to a few small case series in Africa, the risk of spontaneous fetal loss is high and there have been no known neonatal survivors. The mode of EVD transmission is well understood and evidence from the current and previous epidemics indicates that transmission can be interrupted by infection control measures. The central element of providing care to a patient suspected of Ebola is a three-step triage process: identify/isolate/inform. Once the diagnosis is confirmed, because of the potentially worse outcomes seen in pregnancy, specialized multidisciplinary care may be needed. In addition, especially in the obstetric setting, there is a high likelihood of exposure to a potentially deadly disease by health care workers. Therefore, these patients should be managed by anesthetic and obstetric providers in centers with expertise, protocols and training. Labor pain management, and the decision to proceed with cesarean delivery or other obstetric interventions will need to be considered on a case-by-case basis, weighing the risks and benefits to the mother, the fetus and the caregivers.