Abstract
Lassa fever in pregnancy causes high rates of maternal and fetal death, but limited data are available to guide clinicians. We retrospectively studied 30 pregnant Lassa fever patients treated with early ribavirin therapy and a conservative obstetric approach at a teaching hospital in southern Nigeria during January 2009–March 2018. Eleven (36.7%) of 30 women died, and 20/31 (64.5%) pregnancies ended in fetal or perinatal loss. On initial evaluation, 17/30 (56.6%) women had a dead fetus; 10/17 (58.8%) of these patients died, compared with 1/13 (7.7%) of women with a live fetus. Extravaginal bleeding, convulsions, and oliguria each were independently associated with maternal and fetal or perinatal death, whereas seeking care in the third trimester was not. For women with a live fetus at initial evaluation, the positive outcomes observed contrast with previous reports, and they support a conservative approach to obstetric management of Lassa fever in pregnancy in Nigeria.
Highlights
Forty-four cases of Lassa fever (LF) in pregnancy were managed at ISTH during the study period, out of a total of 5,048 pregnant women admitted to ISTH during that period
Our study highlights the contribution of LF to maternal mortality rates at a teaching hospital in Nigeria, where LF was diagnosed in 44/5,048 (0.87%) of all admitted pregnant women but accounted for 11/84 (13.1%) of maternal deaths at the facility during the study period
The 36.7% LF-related maternal mortality rate we report is roughly in the range of a case series described in Sierra Leone in 1988 (21%) [11] and of limited data from Liberia [24], detailed comparison is difficult given the sample sizes involved, decades of separation, and different geographic and genetic contexts
Summary
Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
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