Bibliographic Info
GuidelineWHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Year of Publication2023
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Recommended against
Strong
Certainty of evidence
Very low
Labour should not be induced for foetal indications in pregnant women with acute Ebola virus disease
Notes and Remarks
- 1.There is insufficient evidence to determine if induced abortion or induction of labour impacts maternal outcomes of acute EVD. No recommendation can be made.
- 2.Pregnant women with acute EVD or following recovery (with conception before EVD) who undergo an induced, incomplete, or spontaneous abortion should be provided with post-abortion care as described in the WHO guidelines “Safe abortion: technical and policy guidance for health systems” . Women should be provided instructions on how to handle potentially infectious specimens (such as products of conception) using Ebola-specific IPC measures and personal protective equipment (PPE).
- 3.Pregnant women recovering from EVD should be provided with counselling and necessary information pertaining to the risks of EVD that affect pregnancy outcomes, such as the risk for persistent infectivity of pregnancy-related fluids and tissues after EVD recovery. This information is necessary for women to make an informed decision regarding their choice to continue the pregnancy or undergo induced abortion.
- 4.Health authorities should take steps to expand access to all relevant reproductive options to women during an Ebola outbreak including safe abortion and contraceptive access. Health authorities should also ensure that access to reproductive options are not limited by a woman’s socioeconomic, cultural, racial, or religious status.
- 5.Women who have recovered from EVD but who wish to terminate a pregnancy should receive accurate information about their options and have access to safe abortion and post-abortion care . They should be supported in the choices they make regarding continuation or termination of pregnancy.
- 6.Pregnant women who have recovered from EVD (with conception prior to EVD) may choose to proceed with an induced abortion. Due to the risk of viral persistence in pregnancy-related fluids and tissues, medical abortion (use of medications including misoprostol +/- mifepristone when possible) is preferred to surgical abortion (use of trans-cervical procedures), as surgical abortion may increase risk of EBOV transmission due to the invasiveness of the procedure.
- 7.Follow-up after an uncomplicated medical abortion using mifepristone and misoprostol is not required for obstetric indications. If only misoprostol is used, a follow-up visit is recommended to assess for completion of the abortion. Follow-up visits can be used to monitor symptoms, recovery, and assess the need for contraceptive services.
- 8.Induced abortions should be performed and managed at ETCs or healthcare facilities that are able to follow standard precautions in addition to Ebola-specific IPC measures, and that have the capability to provide obstetric care. Women who proceed with an induced abortion should stay at the facility in which the operation was performed until the abortion is completed due to the potential risk of infection from pregnancy-related fluids and tissues.
- 9.PPE (e.g. double gloves, face mask, gown or coverall and apron, head cover, eye protection (goggles or face shield) and boots in addition to standard precautions should be used when handling pregnancy-related fluids and tissues from women with acute EVD or following recovery (if conception was prior to EVD), given the potential for disease transmission.
- 10.Products of conception should be tested for EBOV using reverse transcriptase polymerase chain reaction (RT-PCR), and should be handled and disposed of using PPE in accordance with established recommendations .
- 11.Women discharged from ETCs should receive Ebola-specific advice and counselling related to pregnancy, abortion, post-abortion care, breastfeeding, and sexual transmission.
- 12.Engagement from multiple stakeholders such as national authorities, epidemic response, UNFPA, UNAIDS and WHO is recommended to provide adequate sexual and reproductive healthcare within the context of Ebola.
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease
Year2020
InstitutionWHO