Clinical management of a pregnant mother expecting twins with H1N1 influenza infection

刘勇¹
shiyan city renmin hospital

OBJECTIVE: To investigate the clinical characteristics and management of the first confirmed case of influenza A (H1N1) infection in a pregnant woman expecting twins in mainland China. METHODS: The clinical manifestations, clinical management and infection control strategies were reviewed and documented. RESULTS: A 29-year old  female patient was admitted to hospital because fetal distress had been detected during routine prenatal screening. The mother had a cough and fever was detected, although no discomfort was reported by the patient. Influenza A (H1N1) virus was detected in the throat swab samples taken from this patient by real-time PCR and DNA sequence analysis. Her symptoms ameliorated quickly with administration of oseltamivir. Acute respiratory distress syndrome (ARDS) developed and mechanical ventilation was promptly implemented. Decreased fetal movement was detected by ultrasound and an emergency cesarean section was carried out. After the operation, the patients condition improved and less positive end-expiratory pressure (PEEP) and FiO 2 were required. The patient's temperature stabilized to normal levels on the third day with oseltamivir. Nucleic acid of Influenza A (H1N1) virus was undetectable after day 6 with oseltamivir management. The patient was weaned from mechanical ventilation seven days later, was extubated the following day and was then transferred to the ward. The patient was discharged on 38 days after hospitalization. CONCLUSIONS: In healthy young people influenza A (H1N1) infection manifests as flu-like symptoms. However, in pregnant women showing these symptoms along with fetal distress further investigation is warranted. Early identification, diagnosis and intervention with oseltamivir, mechanical ventilation and cesarean section, if necessary, might be an effective clinical strategy for the management of this emerging infectious disease in pregnant women.