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The first novel H1N1 patient in the United States was confirmed by laboratory testing at CDC on April 15, 2009. On June 11, 2009, the World Health Organization (WHO) declared a global pandemic of novel influenza A (H1N1).  By June 19, 2009, all 50 states in the United States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have reported novel H1N1 infection.  Soon to follow was the information that pregnant women contracting H1N1 seemed to be developing severe cases that were leading to death.  In early July, 2009 our facility experienced its first severe case of H1N1 on a pregnant woman.  This case study will look at how we shared the science of each discipline to find a solution to providing care.

This case study will look at the quick and severe progression of H1N1 on a 42 year old woman, G8P5116 who was 27 weeks pregnant.  She was initially admitted to a small community hospital with a chief complaint of contractions and shortness of breath.  Her deteriorating respiratory status led to a maternal transport to a tertiary center for higher level of care. The patient, mother of 6 (ages 24 to 3) needed intubation, leaving her 20 year old daughter as the family spokes-person. 

This case was handled by a highly skilled interdisciplinary team which included; the ICU team of nurses & doctors, maternal fetal medicine, labor & delivery nurses,  neonatology and NICU nurses, social workers and chaplains.  The case study will define the roles of the team members, the family conferences, the daily team meetings.  A plan of care was developed and constantly reiterated to the oncoming team members.  The list of emergency equipment and supplies in the room will be identified. 

This case presented many ethical dilemmas.  This presentation will discuss the dilemmas along with the ethical principles involved.  The twenty day progression of the disease and chronology of the case will be reviewed.  The effect to mother and fetus will be defined as well as the final outcome of the case.  This case prompted hospital wide development of guidelines for care.  As a facility we were able to look at what about the plan worked and what could be better.  Presently, like all facilities around the country, monitor the CDC guidelines and make changes as recommended.  At present, our local health department is working with all four city hospitals in a coalition to develop like policies and procedures to deal with H1N1 cases.  Any case solutions related to the care of pregnant patients will be provided.