Introduction Swine flu (Influenza A H1N1) has been implicated in 289 deaths in England since it reached pandemic levels in April 2009. At least 2 pregnant women in the UK are thought to have died directly as a result of H1N1. The authors describe our experiences.
Case 1: A 17-year-old brittle asthmatic, 22 weeks pregnant with twins, was admitted with bibasal pneumonia. Due to hypotension and respiratory failure, she was transferred to the intensive treatment unit. She quickly deteriorated, and ultimately died of fulminant sepsis. Nasal swabs were negative but a presumed diagnosis of H1N1 was made.
Case 2: A 22 year old developed confirmed H1N1 infection in her 3rd trimester. After delivery she required transfer to Leicester for extracorporeal membrane oxygenation (ECMO). She was then transferred to our ITU for ongoing care, where she remains ventilated 9 weeks following delivery.
Case 3: A 17 year old with known asthma was admitted with pneumonia at 22 weeks gestation. H1N1 infection was confirmed on bronchial swabs. She required ventilation for 2 weeks due to respiratory failure.
Discussion Relative immunosuppression in pregnancy means that pregnant women are more likely to become infected with H1N1 and suffer serious complications like pneumonia. They are also more likely to be more seriously affected by these complications. These cases emphasise the importance of taking swabs in feverish pregnant women and, as H1N1 is difficult to isolate from nasal swabs, broncheo-alveolar lavage is recommended. The vaccination of pregnant women should remain a high priority.
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