HINI INFLUENZA AND MATERNAL MORTALITY AND MORBIDITY: A NOVEL NIGHTMARE!
Abstract Number: 148
Abstract Type: Case Report/Case Series
Introduction: In June 2009 WHO classified H1N1 flu a pandemic with a high concern for the most susceptible- elderly, pregnant and those with metabolic disorders.Of the 8000 deliveries at our institution in 2009, several H1N1 cases were encountered; five required ICU admission. We present one of the five parturients who developed morbid respiratory complications with a good outcome.
Case Report: 21 years female, G1P0 at 39 weeks, presented with flu like symptoms- fever, myalgia, cough, and blood tinged sputum. Vital signs: BP 113/37 P140 RR23 Oxygen saturation: 94-98% on 100% Oxygen.
A few hours later, she became increasingly dyspneic and only able to maintain adequate saturations with 100% non-rebreather mask. CXR revealed bilateral infiltrates. WBC 6.9 Hct 31.6 Platelets 201. Urinalysis: 1+ proteinuria. Na 138, K+ 4.1 Cl 107 HCO3 22 BUN 5 Cr 0.5 Gluc 92. Patient weighed 64.5 kg and was 63 inches tall. In the following 12 hours, her shortness of breath and hypoxia worsened. She was emergently intubated and quarantined in the ICU. Even though the PCR or viral culture had not returned, a diagnosis of H1N1 flu was made.
The next morning the fetus began to exhibiting signs of distress. All the appropriate teams coordinated and assembled in MICU to perform a urgent C-section. She received Fentanyl 50mcg, Versed 2mg, and a propofol infusion was at 100 mcg/kg/min. A baby girl was delivered with Apgars of 3/6. The neonate was intubated and sent to the NICU. At the completion of the C- Section, patient had received two liters crystalloids with EBL 600 ml. The neonate was successfully weaned from the ventilator and extubated in 48 hours. The mother, however, was transferred to another facility for ECMO support and underwent a tracheostomy procedure. Within 30 days the parturient was weaned off ventilator support and discharged. Both mother and infant appear to have no residual squealae.
Discussion:Of the five H1N1 cases requiring ICU management in our Facility, four recovered with one death.All four received ECMO support,three with tracheostomy and survived.
Parturients are no more likely to get the H1N1 flu virus than the rest of the population, but they are more likely to develop complications from influenza infection. Most experience mild symptoms of influenza such as fever and cough for a few days and then recover. A small percentage may progress to Pneumonia, ARDS and receive ICU admission.
Confirmation of H1N1 is defined as acute respiratory illness with laboratory confirmation of H1N1 virus infection by real time reverse-transcriptase PCR or viral culture. Because the risk of complications is greater in the later stages of pregnancy and up to six weeks post partum, the best strategy is treat with antivirals within 48 hours of the onset. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality rate in the United States.