Clinical Considerations for Anthrax in Pregnant and Postpartum Women Dana Meaney-Delman, MD MPH Assistant Professor of Gynecology and Obstetrics Emory University School of Medicine Consultant Division of Reproductive Health Centers for Disease Control and Prevention
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Clinical Considerations for Anthrax in Pregnant and Postpartum Women
Clinical Considerations for Anthrax in Pregnant and Postpartum Women. Dana Meaney-Delman, MD MPH Assistant Professor of Gynecology and Obstetrics Emory University School of Medicine Consultant Division of Reproductive Health Centers for Disease Control and Prevention. Overview. - PowerPoint PPT Presentation
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Clinical Considerations for Anthrax in Pregnant and Postpartum Women
Dana Meaney-Delman, MD MPHAssistant Professor of Gynecology and ObstetricsEmory University School of MedicineConsultantDivision of Reproductive HealthCenters for Disease Control and Prevention
Dana Meaney Delman
Not sure how to list my title- think think is ok?
Overview• Review unique features of
pregnant women
• Comprehensive review of reported clinical experience with anthrax in pregnancy and the postpartum period
Dana Meaney Delman
Kate is tasked with outlining the 2012 guidance and I was simply reminding everyone where there are differences. I realize the OBs in the room will know this but I wanted to get us all on the same page
Pregnant and Postpartum Women
Approximately 7 million pregnancies/year Population that is not well studied
Recent H1N1 pandemic experience Complex clinical management decisions Pre-event planning essential to ensure an
efficient public health response and minimize the burden of disease
Ventura et al. National Vital Statistics Report 2009: 58(4): 1-13Cono et al. Emerg Infect Dis 2006;12:11 1631-1637.Pandemic and All-Hazards Preparedness Act. Public Law 109-417. December 19, 2006.
Dana Meaney Delman
No time to go into details but wanted people to have a sense of why preg
Considerations for Infectious Disease in Pregnancy
Maternal• Susceptibility• Severity• Obstetrical Issues• Access to
appropriate treatment
• Adherence
Fetal• Complications from
maternal infection• Congenital
infection• Risks from
diagnostic testing and treatments
Major Physiologic Characteristics of Pregnancy
Organ System Physiologic ChangeImmunologic shift away from cell-mediated immunity
and toward humoral immunityRespiratory increased tidal volume
Maternal & Neonatal Anthrax32 year old P2 experienced spontaneous labor, resulting in
the delivery of a male infant who appeared healthy at birth. Two hours after delivery, the patient developed weak pulse and lethargy, and experienced 1 episode of vomiting. Her respiratory status rapidly deteriorated and she expired 7 hours after delivery. Maternal autopsy revealed mesenteric edema, ascites and mesenteric lymph glands infiltrated with anthrax bacilli.
On day of life 3, infant developed “blue-red” rash over entire body, lethargy, a bloated abdomen and ultimately respiratory failure. Fetal autopsy revealed “enormous numbers of anthrax bacilli” in fetal blood, liver, spleen, kidneys adrenal glands and lungs.Marchand 1886
Results Summary• 20 cases of naturally-occurring anthrax in pregnant and
postpartum women• Most were cutaneous• High maternal mortality proportion overall and higher than
expected with cutaneous infections• Obstetrical complications
– High fetal/neonatal death proportion– PTD reported – Labor coincided with presentation in 3 cases– Delayed diagnosis may have contributed to disease
severity• Perinatal Transmission
– 6/11 fetal/neonatal deaths demonstrate anthrax in fetal tissues
– No evidence of passage of anthrax via in one case of anthrax sepsis
Limitations
• All naturally-occurring• Very old case reports• Few women received antibiotics• Delays (or failure) to make
diagnosis until autopsy
DiscussionAre pregnant and postpartum women more or less susceptible to anthrax than the
general population?• Unclear from this review
Is anthrax infection more severe in pregnant and postpartum women than in the general population?
• High proportion of maternal deaths but limited antibiotic use• Higher rate of death in cutaneous anthrax than reported for general population
Is there an increased risk of adverse obstetrical outcomes in women infected with anthrax?
• Deliveries- both preterm and full term• High proportion of fetal death
Is there a risk of congenital infection in infants whose mothers are infected with anthrax?
• Evidenced of anthrax in fetal tissues
Is there a risk of anthrax transmission through breast milk?• No evidence to date
Implications• Anthrax has substantial morbidity and
mortality in the obstetrical population • Medical countermeasures for pregnant
and postpartum women – should maximize maternal (and fetal)
survival– may involve the use of medications that are
not typically used this population – may need to include antimicrobials with