Treating Women with Zika: A Frontline View from an OB-GYN in Miami

Providing patients with  options can be particularly challenging when so little is known
Providing patients with options can be particularly challenging when so little is known

As a medical student, I remember reading books about the early days of the HIV epidemic and wondering what it was like for doctors to take care of patients who had a new, unknown disease. It seemed to me like it would be frightening for both patients and doctors alike. I didn't expect that early in my career as an OB-GYN, I would be caught in the middle of another new disease outbreak – Zika.

Most people who catch this virus feel fine. Some will end up with a fever, rash, aches and pains and red eyes (conjuntivitis), or rarely, a serious nerve disorder called Guillain-Barre. But in pregnancy there can be very serious consequences to the baby. As of July 28, the World Health Organization reports that nearly 2,000 babies are affected with microcephaly or central nervous system malformations associated with Zika worldwide.

I teach and practice obstetrics and gynecology at the University of Miami Hospital and Jackson Memorial Hospital, and I treat pregnant women who have been infected with Zika: so far over a dozen women. We began preparing to care for infected women in January. Now, it is part of the daily care we provide. And with first known cases of local mosquito-borne transmission in the continental U.S. reported in Wynwood, a neighborhood in Miami, the risk has become even more real.

How am I, and other doctors who care for pregnant women, dealing with this new disease?

Confirming the diagnosis

When I talk to patients these days, I ask them where they or family members have traveled recently. These are questions OB-GYNs across the country may ask pregnant patients. And since I practice in Miami, I might also ask patients if they have been in Wynwood, the neighborhood where local mosquito transmission has occurred. Since Zika is primarily spread by mosquitoes, I also talk with patients about avoiding mosquito bites and using bug repellent. Sexual transmission is also possible, and we talk about that, too.

The patients I worry about the most now are those who live or work in Wynwood and those who've traveled to countries where Zika is more widespread, or those who show the symptoms of Zika infection. We are being vigilant for evidence of spread to other parts of the Miami area.

If I am worried that a pregnant patient has been infected with Zika, I order tests to confirm the diagnosis. The state of Florida has announced that starting next week there will be free Zika testing for all pregnant women through the Department of Health.

If a Zika infection is confirmed, we then have to talk about the risks that she is willing to accept in her pregnancy. If a patient infected with Zika is in her first or second trimester, then we can talk about staying pregnant or having an abortion.

While we think that the first trimester is the time of greatest risk, we still don't know if there is ever a safe point in pregnancy. So how much risk is she willing to accept? What would it mean to have a sick baby in her family? How would she get support no matter what options she chooses? Those answers will be different for everyone.

And these conversations are difficult, because there is still so much we don't know about Zika.

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