Post-Delivery Risk & H1N1

By now, most of us have heard that the H1N1 influenza poses a serious health risk for pregnant women. But you may not be aware that the risk doesn't end with delivery. Women who have just delivered an infant are still considered in the high risk category of those for whom this flu could have dire consequences.

The risk for serious complications rises even higher if pregnant and postpartum women who develop the flu don't receive immediate antiviral treatment. This information was reported by researchers in California and Atlanta, GA ahead of the full report which is to appear in the New England Journal of Medicine. "This pandemic has the potential to notably increase overall maternal mortality in the United States in 2009," warned researchers.

ICU Admittance

Data gathered between April and August of 2009 by the California Department of Public Health, when the pandemic was in its earliest stages showed that 102 pregnant and postpartum women were hospitalized with H1N1 and 22 of them required admittance to an ICU (intensive care unit). Sixteen women had to be placed on ventilators and eight of them died.

Out of the 18 pregnant women who needed to be sent to ICU, 12 delivered their babies, including one set of twins, during their hospitalizations. Eleven of these 13 babies were born premature and required admission to a neonatal ICU. Six of these babies were delivered after their moms were in ICU, including four of them delivered in the ICU by emergency c-sections. This, the authors of the report state, is "a relatively rare obstetrical occurrence [that] suggests that the condition of the patients was too unstable at the time for them to be transferred to an appropriate labor and delivery unit."

Antiviral Treatment

This report was written by four women who work for the California Health Department and for the Centers for Disease Control and Prevention (CDC). The authors underscore their concern that mothers aren't getting antiviral medication within 48 hours after they show signs of the disease, as is indicated.

Of the 22 women requiring attention in the ICU, 6 did not seek medical attention until 5 days had elapsed from their first symptoms. A total of 7 out of these 22 women, were not given antiviral treatment until at least 4 days had passed since they had been seen by their health care providers.

The authors of the report believe these delays in treatment may have occurred as a result of the reluctance of pregnant women to take medications that might affect their babies. Obstetricians are just as hesitant to prescribe these medications. Some women and their doctors may also confuse early flu symptoms such as shortness of breath and muscle aches as typical of the pregnancy experience.

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