Clinical Practice Guideline Monkeypox and pregnancy: the resurgence of an old acquaintance

Abstract

Introduction: Monkeypox is a zoonosis associated with contact with animals, which is original and endemic in countries around Central Africa. In July 2022 a global outbreak was reported, with most of the cases presented in countries outside Africa like the USA, Spain, Germany, and the United Kingdom. Pregnancy is considered as a risk condition, associated with outcomes like spontaneous abortion, preterm birth, and fetal demise. An adequate recognition, diagnosis, management, and tracing diminishes the risk of maternal and perinatal adverse outcomes. Therefore, we considered it necessary to create this Clinical Practice Guideline based on the best available evidence from Maternal Fetal Medicine. Methods: A systematic search was performed in databases (MEDLINE, Embase, LILACS, Google Scholar, Web of Science). After filtering, we finally included 11 articles. Additionally, some other articles found in a nonsystematic search were included given their importance and relevance to achieve this guideline.  Results: Until the drafting of this guideline, only 7 cases of monkeypox infection have been reported in pregnant women. The result of these 5 pregnancies was successful only in one; meanwhile, the remaining 4 cases resulted in spontaneous abortion, fetal demise, preterm birth, and early neonatal death. A high clinical suspicion is essential for an adequate approach in the obstetric patient. The PCR for the diagnosis of monkeypox has shown a high sensibility in multiple series. The antiviral treatment and the intravenous immunoglobulin in pregnancy seems to be the first step in the treatment of symptoms and reduction of transmission. A clear classification for the severity status will allow the clinician to make the right choices around the time of tracing and the place for isolation, with the standardization of the fetal wellbeing follow up.  Conclusions: The monkeypox is an emergent zoonosis that can complicate the pregnancy, the labor and the postpartum, as well as increase the risk of maternal and fetal adverse outcomes. An adequate diagnosis, treatment and tracing will improve the probability of success in pregnant women.