The authors report a confirmed case of H1N1 in a 22 year old who presented at 33 weeks gestation in her second pregnancy. Initial presentation was that of upper respiratory tract infection with rapid deterioration manifesting as pneumonia. She developed tachycardia, tachypnoea, a fever and hypoxia and was immediately admitted to a high-dependancy unit and commenced on antiviral therapy. Owing to progressively worsening pulmonary symptoms with features of adult respiratory distress syndrome, an emergency caesarean section was performed under general anaesthesia. She was transferred to an intensive care unit, where she required mechanical ventilation via prolonged ECMO. She subsequently sustained a haemothorax and required a middle lobectomy. A protracted period of intensive care led to profound myopathy. She is currently stable, breathing independently and undergoing neurological rehabilitation.
This case highlights the increased risk of severe illness of H1N1 virus in young pregnant women. In a recent study the pregnancy death rate was 13 times higher than expected and all deaths were secondary to pneumonia.1 Another case series reports that the only variable associated with a positive outcome was antiviral therapy within 2 days of onset of illness.2 A high index of suspicion, prompt diagnosis and early recourse to antiviral treatment of H1N1 is crucial during pregnancy to prevent major morbidity and mortality.
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