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Complications of Influenza During Pregnancy
Abstract Number: F1D-4
Abstract Type: Case Report/Case Series
With this year’s flu season being worse than it has been in past years, parturients may present to L&D with varying degrees of severity of flu manifestations. We are presenting a case of a 29 year old female, G1P0000, at 23 weeks of gestation, with history significant for morbid obesity (BMI 46) and mild asthma, who presented with pre-term labor and flu like symptoms to the labor and delivery floor.
Our patient was admitted with premature rupture of membranes(PROM), cervical dilation of 4 cms, contractions and flu like symptoms. She was started on tocolytics, betamethasone and oseltamivir. She was also treated with antibiotics for her PROM. Patient continued have painful contractions and epidural was placed for pain control, as per request. No further cervical changes were seen for the next 48 hours. On the third day (postepidural), patient’s respiratory status worsened with tachypnea and desaturation to 75%. Patient was intubated by anesthesia team in the labor room and transferred to OR for emergency cesarean section. Neonate was delivered with apgars 2 and 7. A diagnosis of chorioamnionitis was made. Good uterine tone was achieved, surgeon proceeded to close. Epidural catheter was removed in the OR and patient transferred to SICU.
In SICU patient developed severe ARDS in the setting of chorioamnionitis and pneumonia. Chest xray showing bilateral pulmonary infiltrates and a PaO2/FiO2 ratio <200. ARDSnet protocol was initiated and patient was consulted for ECMO by the cardiothoracic team. She was placed on vasopressor support as well as cisatracurium infusion. Vancomycin, piperacillin and tazobactam were started. Oxygenation progressively improved and she was extubated on POD #3. Patient was closely monitored for neurological deficits suggestive of epidural abscess throughout.
The flu is likely to cause more severe symptoms in pregnancy due to pregnancy related changes of the immune, cardiovascular and respiratory systems. This increased risk extends into the 2 week postpartum period. When symptoms of the flu are present it is imperative to initiate antiviral therapy as soon as possible, preferably within 48 hours of the onset of symptoms regardless of laboratory confirmation. Oral oseltamivir orally for 5 days is the preferred treatment in pregnancy. In previously published cases of flu during pregnancy, outcomes of the cases ranged from uneventful recovery during outpatient treatment with oral oseltamivir, to successful intensive care for manifestations of adult respiratory distress syndrome, to death in the ICU from cardiorespiratory failure. Early recognition, antiviral therapy, acetaminophen and supportive care which may require intensive care are the keys to successful outcomes during pregnancy.
Hymel BJ, Diaz JH, Labrie-Brown CL, Kaye AD. Novel Influenza A (H1N1) Viral Infection in Late Pregnancy: Report of a Case. The Ochsner Journal. 2010;10(1):32-37.