Severe H1N1-infection during pregnancy

  • Sandy Bowkalow
  • Martin Brauer
  • Walter Groß
  • Ekkehard Schleußner
Maternal-Fetal Medicine

Abstract

H1N1 is known to induce fulminant courses in youths and young adults. We report the case of a 24-year gravida 4 para 2 with singleton pregnancy admitted to obstetrical unit for fever up to 38°C during the 20th week of a so far uncomplicated pregnancy. Ultrasound examination and urine test was inconspicuous. Throat complaints were initially relieved during antibiotic therapy, but the patient developed dyspnea with progressing signs of cyanosis. Intubation was necessary on the fifth day because of decreasing oxygen saturation. Coincidentally, progressive pancytopenia and increased inflammatory activity was recorded. Echocardiography, blood cultures, and bronchial lavage brought no pathological findings, but CT revealed acute respiratory distress syndrome and hepatomegaly. Recent human immunodeficiency virus, cytomegalic virus, herpes simplex virus, classical influenza and parainfluenza infections were excluded. An H1N1-infection was confirmed by PCR on the sixth day. The antiviral therapy was changed from zanamivir to oseltamivir. Extracorporeal membrane oxygenation was necessary due to insufficient oxygen saturation by mechanical ventilation. Until this time, pregnancy seemed to be unimpaired, but a sudden spontaneous expulsion of the fetus occurred on the seventh day (weight 460 g, no anomalies detectable). Curettage post abortem was not necessary. As a result of the antiviral therapy, H1N1-DNA was not detectable at day 16. Despite all endeavors, the respiratory situation could not be improved significantly; the patient additionally developed multiorgan failure during the time course and died on the 28th day of treatment. The recent case illustrates a very dangerous and imposing course of an H1N1-infection during pregnancy.

Keywords

H1N1 Influenza Pregnancy ARDS Germany 

References

  1. 1.
    Landt S, Sina F, Kimming R, Schmidt M (2010) H1N1-pregnancy as risk factor. Z Geburtsh Neonatol 214:48–51CrossRefGoogle Scholar
  2. 2.
    Jamieson D et al (2009) H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 374:451–458PubMedCrossRefGoogle Scholar
  3. 3.
    Louie JK et al (2010) Severe 2009 H1N1 influenza in pregnant and postpartum women in California. N Engl J Med 362:27–35PubMedCrossRefGoogle Scholar
  4. 4.
    Vasquez DN, Estenssore E, Cahales HS, Reina R, Saenz MG, Das Neves A (2007) Clinic characteristics and outcomes of Obstetric patients requiring ICU admission. Chest 131:718–724PubMedCrossRefGoogle Scholar
  5. 5.
    RKI (2010) Änderung der Empfehlung zur Impfung der Influenza. Epid Bull 31:1–16Google Scholar
  6. 6.
    Jahromi GS, Zand F, Khosravi A (2010) Acute respiratory distress syndrome associated with H1N1 influenza during pregnancy. Int J Obstet Anesth 19(4):465–466PubMedCrossRefGoogle Scholar
  7. 7.
    Deutsches Ärzteblatt (2011) Höhepunkt der Grippewelle überschritten. dapd/aerzteblatt.de. http://www.aerzteblatt.de/nachrichten/44838/ (Accessed February 2011)
  8. 8.
    Jimenenz MF, El Beitune P, Salcedo MP, Von Ameln AV, Mastalir FP, Braun LD (2010) Outcome for pregnant women infected with influenza A (H1N1) virus during the 2009 pandemic in Porto Alegre, Brazil. Int J Gynaecol Obstet 111(3):217–219CrossRefGoogle Scholar
  9. 9.
    European Center for Disease Prevention and Control (ECDC) (2010) ECDC forward look risk assessment. Likely scenarios for influenza in 2010 and the 2010/2011 influenza season in Europe and the consequent work priorities. ECDC. http://www.ecdc.europa.eu/en/healthtopics/H1N1/Documents/1003_RA_forward_look_influenza.pdf (Accessed October 2010)
  10. 10.
    ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System (2010) Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ 340:c1279Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sandy Bowkalow
    • 1
  • Martin Brauer
    • 2
  • Walter Groß
    • 3
  • Ekkehard Schleußner
    • 1
  1. 1.Department of Obstetrics and Gynecology, Jena University HospitalFriedrich-Schiller-UniversityJenaGermany
  2. 2.Department of Anaestesiology and Intensive CareJena University Hospital, Friedrich-Schiller-UniversityJenaGermany
  3. 3.Department of Obstetrics and Gynecology, SRH HospitalGeraGermany

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