Novel Influenza A(H1N1) Virus Among Gravid Admissions

Background: Pandemic novel influenza A(HIN1) is a substantial threat and cause of morbidity and mortality in the pregnant population Methods: We conducted an observational analysis of 18 gravid patients with-H1N1 in 2 academic medical centers Cases were identified based-on direct antigen testing (DAT) of nasopharyngeal swabs followed by real-time reverse-transcriptase polymerase chain reaction analysis (rRT-PCR) or viral culture Patient demographics, symptoms, hospital course, laboratory and radiographic results, pregnancy outcome, and placental pathologic information were recorded Results were then compared with published reports of the H1N1 outbreak and reports of flu pandemics of 1918 and 1957. Results: Eighteen pregnant patients were admitted with H IN I during the study period All patients were treated with oseltamivir phosphate beginning on the day of admission Mean (SD) age was 27 (6 6) years (age range, 18-40 years), median length of hospital stay was 4 days Intensive care unit admission rate was 17% (n=3) Demographically, 2 patients were health care workers (11%), 1.5 were black (83%), 2, Hispanic (11%), and I, white (6%) None reported recent travel Half of the patients presented with gastrointestinal or abdominal complaints, 13 patients met sepsis criteria (72%) The most common comorbidities were asthma, sickle cell disease, and diabetes. Fourteen patients tested positive for H1N1 on DAT (initial or repeated) (78%), in the other 4 cases, HIN1 was identified by viral culture or rRT-PCR (22%) Seven patients delivered during hospitalization (39%), 6 prematurely and 4 via emergency cesarean delivery. There were 2 fetal deaths (11%) No maternal mortality was recorded Conclusions: Admitted pregnant patients with HIN1 are at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death A high number of patients presented with gastrointestinal and abdominal complaints Early antiviral treatment may improve maternal outcomes