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EMERGENCY
MEDICINE

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FIGURE 1. Updated interim guidance: testing algorithm for a pregnant woman with history of travel to an area with ongoing Zika virus
transmission (Source: Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: Interim Guidelines for Health Care Providers Caring for
Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal
Wkly Rep 2016;65(Early Release):1–6.)

isolated fetal microcephaly should be defined as fetal head circum- and unlikely to be harmful for the neonate. The benefits of breast-
ference >3 SD or more below the mean for gestational age on peri- feeding likely outweigh the potential neonatal risks. Therefore, cur-
natal ultrasound and that certain diagnosis of pathologic rently the recommendation is that women should continue to
microcephaly is considered certain when the fetal HC is > 5 SD. breastfeed.

Providers should be aware that different evaluation/management For partners of pregnant women who have traveled to one of the
algorithms are in place for pregnant women who live in endemic affected countries, because of the concern for possible sexual trans-
areas. This algorithm can be found on the CDC website. Other mission, current CDC guidelines recommend consideration of ab-
pregnancy considerations include cases of miscarriage or stillbirth staining from sexual activity or using condoms consistently and
in women with suspected or diagnosed Zika virus infection. In these correctly during sex.
cases, fetal remains and placenta should be sent to pathology for
evaluation for presence of Zika virus. The capacity to breast feed is For women or their partners considering pregnancy, there are no
also an issue that has been questioned. Although the presence of clear guidelines to base care at this time. There is no evidence avail-
Zika in breast milk has been reported, it is in very small amounts able at this time to suggest that Zika virus, after it has cleared from
the blood, poses a potential risk of birth defects in future pregnan-

14 San Antonio Medicine • March 2016