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Pregnant women with influenza are at risk for increased morbidity and mortality during an influenza pandemic, as was demonstrated in the pandemics of 1918-1919 and 1957-1958.  With the identification, in the spring of 2009 of a novel influenza A (H1N1) virus that is transmissible among humans, obstetrical providers and caregivers must be prepared to care for these women.

In healthy adults influenza is usually an uncomplicated illness that rarely kills.  However, pregnant women have been shown to be at high risk for complications during influenza pandemics.  Rasmussen, et al (2008) report that among 1,350 reported cases of influenza among pregnant women during the pandemic of 1918, the proportion of deaths was 27%.  The pandemic of 1918 also demonstrated two unique features: a high case-fatality rate at all ages and an excess of mortality among 20-40 year old individuals, childbearing age. (Morens, 2007). 

This presentation will relay the story of a woman in her mid-20’s found to be positive for H1N1 influenza in the third trimester.  Her course in the hospital, from admission to the High Risk Antepartum unit to transfer to the Medical ICU for intubation and ultimate discharge home at 34+1 week will be outlined.  Maternal influenza infection and the effect on the fetus is not well defined.  High  rates of spontaneous abortion and preterm birth were reported with the ‘Spanish flu’ in 1918 and  birth defects, spontaneous pregnancy loss, fetal death and preterm delivery were reported during the ‘Asian flu’ pandemic of 1957 (Rasmussen, 2008).  This mother would go on to deliver an apparently healthy full term male infant.

The CDC currently recommends early treatment with influenza antiviral medications for pregnant women with suspected influenza illness.  Other recommendations to reduce the risk for pregnant women include good hand hygiene with frequent washing; minimizing contact with potentially sick persons; avoidance of crowds; and adherence to good cough etiquette.  The infant is also at risk for infection and further hospitalization especially if not breastfeeding.  Only healthy adults should care for newborns.  Good hand hygiene and cough etiquette should be followed.  If the mother is sick, breast milk may be expressed for bottle feeding.  This case study demonstrates how sharing the evidence available through analysis of past pandemics can lead to finding solutions and positive outcomes for childbearing women of the 21st century.