Guideline

Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease

Year of Publication

2020

Issuing Institution

WHO

Links

WHO IRIS,Google Scholar

Recommendations

13 included recommendations

Clinical management for all pregnant women (pregnant women with acute Ebola virus disease) should include optimized supportive care

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In the context of rigorous research or in accordance with the MEURI protocol, the use of the investigational therapies REGN-EB3 or mAb114 may be offered to pregnant women with Ebola virus disease

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Labour should not be induced for foetal indications in pregnant women with acute Ebola virus disease

Status

Maintained

Recommended against

Strong

Certainty of evidence

Very low

Invasive procedures should not be performed for foetal indications in pregnant women with acute Ebola virus disease

Status

Maintained

Recommended against

Strong

Certainty of evidence

Very low

All pregnant women with acute Ebola virus disease should be managed using both standard precautions and Ebola-specific Infection Prevention and Control (IPC) measures

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

All pregnant women who have recovered from Ebola virus disease (with conception prior to Ebola virus disease) should be enabled and encouraged to attend frequent Antenatal Care (ANC). If there is no risk of exposure to pregnancy-related fluids during the ANC visit, only standard precautions are required. Complications associated with childbirth and pregnancy should be managed at Ebola treatment centres (ETCs): and Ebola Infection Prevention and Control (IPC) measures should be used in addition to standard precautions

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Among women who become pregnant after Ebola virus disease (with conception after acute Ebola virus disease), standard Infection Prevention and Control (IPC) precautions should be used.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Surgically removing foetal tissue from the uterus following maternal demise from Ebola virus disease (occasionally termed ‘post-mortem caesarean’) may pose a risk of transmission to contacts and should be strongly discouraged.

Status

Maintained

Recommended against

Strong

Certainty of evidence

Very low

Pregnant and breastfeeding women should be offered vaccination with the prequalified Ervebo (Merck) live-replicating rVSV-ZEBOV-GP vaccine during an active Zaire Ebola virus outbreak in affected areas, in the context of rigorous research or in accordance with a compassionate use protocol. Vaccination should occur with informed consent and in compliance with good clinical practice

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A woman who has recovered from Ebola virus disease, cleared viremia, and wants to continue breastfeeding should wait until she has had two consecutive negative RT-PCR breastmilk tests for Ebola virus by, separated by 24 hours. During this time, the child should be given a breastmilk substitute

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Breastfeeding should be stopped if acute Ebola virus disease is suspected or confirmed in a lactating woman or in a breastfeeding child. The child should be separated from the breastfeeding woman and provided a breastmilk substitute as needed.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

Children without confirmed Ebola virus infection who are exposed to the breastmilk of women with confirmed Ebola virus disease should be considered contacts. The child should stop breastfeeding and should undergo close monitoring for signs and symptoms of Ebola virus disease for 21 days. The child should be given a breastmilk substitute as needed. Post-exposure prophylaxis for Ebola virus disease can be considered for children exposed to the breastmilk of Ebola virus-infected women on a case-by-case basis and in accordance with existing research protocols

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

If a lactating woman and her breastfeeding child are both diagnosed with Ebola virus disease, breastfeeding should be discontinued, the pair should be separated, and appropriate breastmilk substitutes should be provided. However, if the child is under six months of age and does not have safe and appropriate breastmilk substitutes, or the child cannot be adequately cared for, then the option to not separate and continue breastfeeding can be considered

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low