Crimean-Congo haemorrhagic fever in pregnancy: about three in ten mothers died

Design

Systematic review with pooled patient-level data from published and unpublished cases

Population

55 pregnancies with Crimean-Congo haemorrhagic fever in endemic regions

Primary outcome

Maternal mortality and fetal loss

Effect

Maternal mortality 28.8% (15/52); fetal loss 57.4% (31/54); third-trimester ribavirin OR 0.33 (95% CI 0.13-0.84) for maternal death

Investigators pooled patient-level data on 55 pregnancies complicated by Crimean-Congo haemorrhagic fever (CCHF), drawing on published case reports and unpublished cases from centres in endemic regions. Because the source material is case reports and case series, this is the best available picture rather than a controlled comparison.

Maternal mortality was 28.8% (15 of 52 with known outcome) and fetal loss 57.4% (31 of 54). Maternal deaths rose with gestation, to 31.3% in the third trimester, whereas fetal loss was highest in the first trimester at 85.7%. Third-trimester ribavirin was associated with lower observed maternal mortality (odds ratio 0.33, 95% CI 0.13-0.84).

CCHF is tick-borne and also spreads through contact with infected blood, including in delivery rooms. India has reported outbreaks, mainly in Gujarat and Rajasthan, so this is not a remote concern for obstetric units in the west of the country. The practical point is early suspicion, early isolation and early involvement of infectious disease and public health teams, not a change in routine antenatal care.

• Consider CCHF in a pregnant woman with fever, bleeding and low platelets after tick bites, livestock handling or slaughter exposure in an endemic area.
• Use contact and blood-borne precautions early: health-worker infection during delivery and surgery is a recognised route.
• Notify the district surveillance unit and involve infectious disease colleagues as soon as CCHF is suspected.
• Third-trimester ribavirin was linked to fewer maternal deaths in this series; discuss its use case by case with infectious disease specialists.
• Counsel that fetal loss is common, especially in the first trimester.

Why it matters

A haemorrhagic fever that kills about three in ten pregnant women can present to an Indian labour ward looking like HELLP or sepsis.

Don't overread it

The ribavirin signal comes from pooled case reports with no randomisation; sicker or later-presenting women may simply have missed treatment.

The statistics, in plain English

An odds ratio of 0.33 means the odds of death were about a third as high among those given ribavirin. The confidence interval (0.13 to 0.84) stays below 1, so chance alone is an unlikely explanation, but with 55 pregnancies from case reports, who got treated and when is a much bigger source of bias than chance.

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