Médecins sans Frontières, Geneva, Switzerland.
PLoS Negl Trop Dis. 2013 Aug 15;7(8):e2368. doi: 10.1371/journal.pntd.0002368. eCollection 2013.
The association between cholera in pregnancy and negative fetal outcome has been described since the 19(th) century. However, there is limited published literature on the subject. We describe pregnancy outcomes from a specialized multidisciplinary hospital unit at the onset of a large cholera outbreak in Haiti in 2010 and 2011.
Pregnant women with cholera were hospitalized in a specialized unit within the MSF hospital compound in Léogâne and treated using standard cholera treatment guidelines but with earlier, more intense fluid replacement. All women had intravenous access established at admission regardless of their hydration status, and all received antibiotic treatment. Data were collected on patient demographics, pregnancy and cholera status, and pregnancy outcome. In this analysis we calculated risk ratios for fetal death and performed logistic regression analysis to control for confounding factors.
263 pregnant women with cholera were hospitalized between December 2010 and July 2011. None died during hospitalization, 226 (86%) were discharged with a preserved pregnancy and 16 (6%) had live fullterm singleton births, of whom 2 died within the first 5 days postpartum. The remaining 21 pregnancies (8%) resulted in intrauterine fetal death. The risk of fetal death was associated with factors reflecting severity of the cholera episode: after adjusting for confounding factors, the strongest risk factor for fetal death was severe maternal dehydration (adjusted risk ratio for severe vs. mild dehydration was 9.4, 95% CI 2.5-35.3, p = 0.005), followed by severe vomiting (adjusted risk ratio 5.1, 95% 1.1-23.8, p = 0.041).
This is the largest cohort of pregnant women with cholera described to date. The main risk factor identified for fetal death was severity of dehydration. Our experience suggests that establishing specialized multidisciplinary units which facilitate close follow-up of both pregnancy and dehydration status due to cholera could be beneficial for patients, especially in large epidemics.
自 19 世纪以来，人们就已经描述了妊娠霍乱与不良胎儿结局之间的关联。然而，关于这一主题的文献发表有限。我们描述了 2010 年和 2011 年海地大规模霍乱疫情爆发期间，在一家专门的多学科医院病房中孕妇的妊娠结局。
患有霍乱的孕妇被收入位于莱奥甘的无国界医生组织医院院内的一个专门病房进行治疗，采用标准的霍乱治疗指南，但补液更为积极。所有孕妇入院时都建立了静脉通路，无论其水合状态如何，所有孕妇都接受了抗生素治疗。我们收集了患者的人口统计学、妊娠和霍乱状况以及妊娠结局数据。在此分析中，我们计算了胎儿死亡的风险比，并进行了逻辑回归分析以控制混杂因素。
2010 年 12 月至 2011 年 7 月期间，共有 263 名患有霍乱的孕妇住院。住院期间无孕妇死亡，226 名（86%）孕妇出院时妊娠得到保留，16 名（6%）孕妇足月单胎活产，其中 2 名在产后 5 天内死亡。其余 21 例（8%）妊娠导致宫内胎儿死亡。胎儿死亡的风险与反映霍乱严重程度的因素有关：在调整混杂因素后，胎儿死亡的最强风险因素是严重的产妇脱水（严重脱水与轻度脱水的调整风险比为 9.4，95%CI 2.5-35.3，p=0.005），其次是严重呕吐（调整风险比 5.1，95%CI 1.1-23.8，p=0.041）。
这是迄今为止描述的最大的孕妇霍乱队列。确定的胎儿死亡的主要危险因素是脱水的严重程度。我们的经验表明，建立专门的多学科病房，有利于密切监测妊娠和霍乱引起的脱水情况，这对患者有益，特别是在大规模流行期间。
