Cholera in Pregnancy Is Associated with High Risk of Stillbirth Or Abortion

Pregnancy and cholera; pregnancy outcomes from specialized cholera treatment unit for pregnant women in Leogane, Haiti

Mathieu Bichet*, Iza Ciglenecki*, Javier Tena*, Nelly Staderini*

*Médecins Sans Frontières, Geneva, Switzerland

Corresponding author: Iza Ciglenecki ()

Ethical approval: Not required for retrospective analysis of routinely collected data that does not contain patient identifiers.

No Conflict of Interest and no funding source external to MSF.

Introduction

Cholera in pregnancy is associated with high risk of stillbirth or abortion. Reported foetal loss, in the limited literature available, varies between 13.5 and 53%.

In Haiti, over 270’000 cholera cases were registered between October 2010 and March 2011. Since the beginning of the outbreak anecdotic accounts spoke of high foetal loss among women delivering in the cholera treatment units.

A specialised cholera isolation unit for pregnant women was set-up inside the MSF hospital compound in Leogane, Haiti. Treatment for obstetric complications was available, including C-section, neonatal resuscitation and intensive care unit.

We used WHO protocols for cholera treatment, but were more aggressive in terms of fluid and glucose replacement. All women had intravenous access established at admission regardless of hydration status. All received antibiotic treatment with erythromycin. Glucose was systematically added to intravenous treatment to prevent hypoglycaemia. Foetal status was monitored during hospitalisation, either clinically or with ultrasound.

We present the outcome of the pregnancy from the routinely collected data in the Leogane specialised cholera treatment unit.

Methods

We collected demographic and clinical data regarding the pregnancy and the cholera episode. Data were entered in Excel and analysed with SPSS.

Results

Between 13th December 2010 and 28th February 2011, 102 pregnant women were admitted in the cholera treatment unit. Of 102 women, 14 (13.7%) were in 1st trimester, 50 (49%) in 2nd and 38 (37.3%) in the 3rd trimester of pregnancy. Median age was 26 years (range 16-43). At admission, 46 patients (45.1%) were mildly dehydrated (plan A), 44 (43.1%) moderately (plan B) and 11 (10.8%) severely dehydrated (plan C). Median delay between admission in the CTU and beginning of the symptoms was 1 day (range 0-6 days).

No maternal death occurred during admission in the unit. Of the 102 pregnant women, 81 (79.4%) preserved their pregnancy, 7 delivered a live newborn (6.9%), with one neonatal death 5 days later and there were 14 (13.7%) foetal deaths - 7 abortions and 7 stillbirths. Seven foetal losses occurred before admission, 5 in the 2nd and 2 in the 3rd trimester.

Conclusions

This is one of the largest descriptions of outcomes of pregnancy in cholera-infected patients. Our results of foetal loss are comparable or better than most of the other published results.

Pregnant women with cholera are at particular risk. Rigorous rehydration, avoiding even short periods of severe dehydration is important to prevent transitional hypoxia in placenta. We recommend establishment of specialized units for pregnant women during bigger cholera outbreaks to allow closer and adapted follow-up of both cholera and pregnancy status.