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 Health workers have very little time to decide whether a pregnant
women with complications is free of Ebola and should have the
necessary intervention, or may have Ebola and should have minimal
procedures, experts said in BJOG: An International Journal of
Obstetrics and Gynecology.
Dr Benjamin Black, a specialist in obstetrics and gynecology, said
poor infrastructure and limited access to laboratory services meant
that test results for suspected Ebola patients could take more than
24 hours to arrive, in which time a woman and her fetus may die.
Health workers dealing with childbirth are at particular risk of
infection because they are frequently exposed to large quantities of
bodily fluids, including blood, urine and faeces.
Medecins Sans Frontières (MSF), which opened in Sierra Leone on
Saturday the first care center for pregnant women in the current
Ebola epidemic, said the survival rate from the virus for expectant
mothers was virtually zero. (id:USKBN0KJ0PH)
"The overlap in diagnostic criteria, but with contradictory
treatment strategies, creates an ethical conundrum for the
obstetrician in an Ebola epidemic," Black wrote in a commentary.
"The decision on whether to isolate a woman or not is potentially a
decision between life and death, for both the patient and the health
worker."
Due to the stigma, rumors and fear surrounding Ebola, pregnant women
often wait until they are in a critical state before seeking
treatment, further challenging the system of prioritizing patients,
Black said.
While the rate of transmission has slowed in Guinea and Liberia and
signs indicate it is starting to ebb in Sierra Leone, the journal
said that once-functioning health structures were now deserted by
patients and staff, as many have died from Ebola while others fear
working and have gone on strike.
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In a separate commentary published in the journal, three Public
Health England (PHE) authors said data on pregnancy outcomes in the
current epidemic was relatively scarce.
Limited evidence suggested that maternal mortality rates are high
among Ebola virus-infected pregnant women, who are at increased risk
of spontaneous abortion, pregnancy-related hemorrhage, stillbirth
and death, they said.
"While high neonatal mortality rates have been previously reported,
it hasn't always been known whether these deaths were caused by
Ebola or the many other causes of high infant mortality," the PHE
commentary said.
More than 21,000 people have been infected with the virus in Guinea,
Sierra Leone and Liberia since the current outbreak in West Africa
began a year ago and at least 8,300 people have died, according to
World Health Organization figures. (id:AFKBN0KL284)
(Reporting By Kieran Guilbert; Editing by Tim Pearce)
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