H1N1 in Pregnant Women Is Serious Threat to Fetuses

Those with H1N1 at increased risk for emergency cesarean, fetal distress/mortality
By Lindsey Marcellin
HealthDay Reporter

TUESDAY, May 25 (HealthDay News) -- Pregnant women admitted to the hospital with pandemic novel influenza A(H1N1) are at increased risk for abdominal and gastrointestinal symptoms, fetal distress and mortality, emergency cesarean delivery, and premature births, according to research published in the May 24 issue of the Archives of Internal Medicine.

Andrew C. Miller, M.D., of the State University of New York Downstate Medical Center in Brooklyn, and colleagues conducted an observational study of 18 gravid patients with H1N1 in two academic medical centers. Cases were identified either by direct antigen testing of nasopharyngeal swabs confirmed by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) analysis, or by viral culture. The researchers compared the patients' medical data with published reports of the H1N1 outbreak, as well as with reports of influenza pandemics in 1918 and 1957.

The researchers found that gastrointestinal symptoms were the presenting symptoms in half of the patients, and 72 percent met sepsis criteria. The most common comorbidities were asthma, diabetes and sickle cell disease. All 18 patients admitted during the study period were treated with oseltamivir beginning on the day of admission. Three women (17 percent) required intensive care unit admission. Seven patients delivered during the hospitalization, all but one of them premature births, and four of them by emergency cesarean section.

"If a high index of suspicion exists, patients should be empirically treated with antiviral agents. Confirmatory testing with viral culture or rRT-PCR may be undertaken. Fetal distress necessitating emergency delivery or cesarean delivery may result in significant morbidity. The absence of maternal mortality in the present series (versus its presence in prior studies) may be related to early antiviral treatment," the authors write.

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