Monkeypox in pregnancy: virology, clinical presentation, and obstetric management.
Details
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_91B6EDFE5E43
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Monkeypox in pregnancy: virology, clinical presentation, and obstetric management.
Journal
American journal of obstetrics and gynecology
ISSN
1097-6868 (Electronic)
ISSN-L
0002-9378
Publication state
Published
Issued date
12/2022
Peer-reviewed
Oui
Volume
227
Number
6
Pages
849-861.e7
Language
english
Notes
Publication types: Review ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
The 2022 monkeypox outbreak, caused by the zoonotic monkeypox virus, has spread across 6 World Health Organization regions (the Americas, Africa, Europe, Eastern Mediterranean, Western Pacific, and South-East Asia) and was declared a public health emergency of international concern on July 23, 2022. The global situation is especially concerning given the atypically high rate of person-to-person transmission, which suggests viral evolution to an established human pathogen. Pregnant women are at heightened risk of vertical transmission of the monkeypox virus because of immune vulnerability and natural depletion of population immunity to smallpox among reproductive-age women, and because orthopoxviral cell entry mechanisms can overcome the typically viral-resistant syncytiotrophoblast barrier within the placenta. Data on pregnancy outcomes following monkeypox infection are scarce but include reports of miscarriage, intrauterine demise, preterm birth, and congenital infection. This article forecasts the issues that maternity units might face and proposes guidelines to protect the health of pregnant women and fetuses exposed to the monkeypox virus. We review the pathophysiology and clinical features of monkeypox infection and discuss the obstetrical implications of the unusually high prevalence of anogenital lesions. We describe the use of real-time polymerase chain reaction tests from mucocutaneous and oropharyngeal sites to confirm infection, and share an algorithm for the antenatal management of pregnant women with monkeypox virus exposure. On the basis of the best available knowledge from prenatal orthopoxvirus infections, we discuss the sonographic features of congenital monkeypox and the role of invasive testing in establishing fetal infection. We suggest a protocol for cesarean delivery to avoid the horizontal transmission of the monkeypox virus at birth and address the controversy of mother-infant separation in the postpartum period. Obstetrical concerns related to antiviral therapy with tecovirimat and vaccinia immune globulin are highlighted, including the risks of heart rate-corrected QT-interval prolongation, inaccuracies in blood glucose monitoring, and the predisposition to iatrogenic venous thromboembolism. The possibility of monkeypox vaccine hesitancy during pregnancy is discussed, and strategies are offered to mitigate these risks. Finally, we conclude with a research proposal to address knowledge gaps related to the impact of monkeypox infection on maternal, fetal, and neonatal health.
Keywords
Infant, Newborn, Infant, Female, Humans, Pregnancy, Monkeypox/diagnosis, Monkeypox/epidemiology, Blood Glucose Self-Monitoring, Premature Birth, Blood Glucose, Monkeypox virus, ACAM2000, COVID-19, MVA-BN, World Health Organization, antiviral, chickenpox, cidofovir, cowpox, emerging pathogen, miscarriage, monkeypox, obstetrical management, orthopoxvirus, outbreak, pregnancy, rash, sexual transmission, smallpox, tecovirimat, vaccine, vaccinia immune globulin, vaccinia virus, varicella-zoster, vertical transmission, zoonosis
Pubmed
Open Access
Yes
Create date
30/08/2022 11:35
Last modification date
25/01/2024 8:40