Nursing Management of Ebola & Pregnancy

Ebola virus (EBV) is one of several viruses known as viral hemorrhagic fevers. The virus attacks all body organs. EBV enters the body through the eyes, ears, nose, mucous membranes and skin abrasions and opening. The virus can be transmitted via body fluids such as sweat, saliva, semen, breast milk and vaginal fluids.1

There are many changes to the immune system during pregnancy. These changes can predispose the pregnant women to intracellular parasites, viruses, bacteria such as Ebola virus.2

The EBV is very detrimental to obstetrics patients and fetuses. There is a high incidence of minimal survival for the obstetric patients and their infants. Usually, maternal deaths occur due to hypovolemic shock. There is a high incidence of spontaneous abortion as a result of intravascular coagulopathy and pyrexia.2

Nursing Assessment

Healthcare providers should assess every obstetrics patient for the risk of EBV infection. Per CDC, the Ebola symptoms may present from two to 21 days after exposure to Ebola, but the average is eight to 10 days.3

Nursing assessment should also include:

  • assessing all pregnant women for high, low and no known risk exposure.
  • assessing for signs and symptoms of Ebola, recent residence and travel to a country with a recent outbreak of Ebola virus and recent direct handle of bats or non-human primates such as gorilla or monkeys.
  • assessing for contact with body fluids with somebody suspected of having the virus.

According to CDC, a high-risk exposure includes any of the following:

  • Percutaneous (e.g., needlestick) or mucous membrane exposure to blood or body fluids of EVD patient
  • Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE)
  • Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
  • Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring

A low risk exposure includes any of the following:

  • Household contact with an EVD patient
  • Other close contacts with EVD patients in healthcare facilities or community settings. Close contact is defined as being within approximately three feet (one meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; b. Having direct, brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
  • Brief interactions, such as walking by a person or moving through the hospital, do not constitute close contact
  • No known exposure includes having been in the country in which an EVD outbreak occurred within the past 21 days and having had no high or low-risk exposures.

Clinical Diagnosis

During the antepartum, the clinical diagnosis of Ebola in a pregnant woman is difficult because there are other clinical issues that imitate the symptoms of Ebola such as chorioamnionitis, placenta previa. Study suggested that during Ebola outbreak, healthcare practitioners should critically monitor obstetrics patients with vaginal bleeding and other risk factors for EBV.2

During intrapartum and postpartum period, the fetal tracing should be monitored and for category II and II tracings. The nurse should be ready to manage potential hemorrhage. If the patient and infant survived, breastfeeding should be discouraged since the virus has been detected in the breast milk.3
Some of the clinical manifestations of Ebola virus infection in obstetrics include: fever, weakness, abdominal pain, conjunctivitis, anorexia, diarrhea, hiccups, joint pain, shock, dysphagia, nausea, vomiting, coma, retrosternal pain, seizures, and an increased respiratory rate.

Signs of hemorrhage, such as petechiae, hematuria, increase vaginal bleeding/lochia, dark stools, bleeding from injection sites, bleeding gums, hematemesis, and patient may also complain of neurological and psychiatric symptoms, such as apathy, headaches, coma, anxiety, delirium decreased consciousness and convulsions.1-4

Some potential nursing diagnoses include:

  • Risk for infection
  • Ineffective airway clearance
  • Risk for aspiration
  • Risk for bleeding
  • Risk for peripheral neurovascular dysfunction
  • Risk for shock
  • Impaired skin integrity
  • Risk for impaired skin integrity
  • Impaired tissue integrity
  • Risk for trauma
  • Risk for vascular trauma
  • Impaired comfort
  • Nausea
  • Acute pain
  • Chronic pain
  • Impaired comfort
  • Social Isolation

Clinical Management

Upon the identification of pregnant patients with EBV, CDC’s Standard, Contact, and Droplet Precautions Recommended for Prevention of EVD Transmission in U.S. Hospitals should be followed.5

In triage, LDRs, PACU and operating rooms, CDC recommends isolating the suspected or confirmed Ebola virus patient and placing the patient under contact and fluid precaution.

To avoid contamination and exposure to the virus, CDC is recommending that all staff should wear PPE and correctly remove PPE without contaminating any mucous membranes and clothing.

Additional recommendations are also given for managing patient Care Equipment; Patient Care Considerations; limiting Aerosol Generating Procedures (AGPs); proper Hand Hygiene; Environmental Infection Control; Safe Injection practices; Duration of Infection Control Precautions; how to Monitoring and Management of Potentially Exposed Personnel; and how to Monitor, Manage, and Train Visitors of the patients.5

Currently, the primary treatment for Ebola is a blood transfusion from a survivor and experimental drugs. The clinical recommendations are to provide supportive clinical care and to treat symptoms as they present.

The pregnant woman may be managed with intrauterine interventions, intravenous fluids, blood transfusions, and balance of electrolytes, maintenance of excellent oxygenation and blood pressure, and decrease body temperatures.1-3

Nursing interventions should also include providing safety and pain management. Efforts should also be made to provide bereavement support to the patients and their families. 

References for this article can be accessed here.

Chi-Chi Echezona-Johnson is Assistant Director of Nursing/Women and Children Nursing Education, Metropolitan Hospital Center, New York, N.Y.

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