Severe acute respiratory syndrome (SARS) is a serious illness caused by the SARS-associated corona virus (SARS-CoV). SARS first appeared in China, and spread to North American by 2003. MERS was discovered in the Arabian Peninsula in 2012 and has already appeared in North America. Diagnosis and treatment of MERS in pregnancy should be addressed prior to any large outbreaks in North America.
A review of SARS/MERS in pregnancy cases plus discussions with infectious disease specialists and the IIDSOG Emerging Infections Division.
Three cases of MERS in pregnancy have been reported. One led to stillbirth at 20 weeks, the second resulted in maternal death immediately after cesarean section, and the third delivered and recovered without any long term complications. Because of limited numbers of MERS cases, SARS cases were examined. In the twelve reported cases of SARS in pregnancy, the case fatality rate of 25%, ICU admission (50%) and mechanical ventilation (33%), compared with the non-pregnant population (20%). Also, 57% of patients had spontaneous miscarriage, and 84% who presented after 24 weeks were delivered preterm.
MERS has the potential to be a serious epidemic. Our recommendations for pregnant patients with MERS include: 1) Standard supportive measures for critically ill respiratory infection 2) Early delivery to better permit ventilation 3) Preventive measures at delivery, including nasopharyngeal suction and cleansing to reduce the viral load. Cesarean section at this time is not encouraged 4) Isolation of the mother from neonate until incubation period (14 days) is completed 5) Delay breast feeding until antibodies are detected in breastmilk.