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Novel influenza A(H1N1) virus among gravid admissions.
Arch Intern Med. 2010 May 24; 170(10):868-73.AI

Abstract

BACKGROUND

Pandemic novel influenza A(H1N1) is a substantial threat and cause of morbidity and mortality in the pregnant population.

METHODS

We conducted an observational analysis of 18 gravid patients with H1N1 in 2 academic medical centers. Cases were identified based on direct antigen testing (DAT) of nasopharyngeal swabs followed by real-time reverse-transcriptase polymerase chain reaction analysis (rRT-PCR) or viral culture. Patient demographics, symptoms, hospital course, laboratory and radiographic results, pregnancy outcome, and placental pathologic information were recorded. Results were then compared with published reports of the H1N1 outbreak and reports of flu pandemics of 1918 and 1957.

RESULTS

Eighteen pregnant patients were admitted with H1N1 during the study period. All patients were treated with oseltamivir phosphate beginning on the day of admission. Mean (SD) age was 27 (6.6) years (age range, 18-40 years); median length of hospital stay was 4 days. Intensive care unit admission rate was 17% (n = 3). Demographically, 2 patients were health care workers (11%); 15 were black (83%); 2, Hispanic (11%); and 1, white (6%). None reported recent travel. Half of the patients presented with gastrointestinal or abdominal complaints; 13 patients met sepsis criteria (72%). The most common comorbidities were asthma, sickle cell disease, and diabetes. Fourteen patients tested positive for H1N1 on DAT (initial or repeated) (78%); in the other 4 cases, H1N1 was identified by viral culture or rRT-PCR (22%). Seven patients delivered during hospitalization (39%), 6 prematurely and 4 via emergency cesarean delivery. There were 2 fetal deaths (11%). No maternal mortality was recorded.

CONCLUSIONS

Admitted pregnant patients with H1N1 are at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death. A high number of patients presented with gastrointestinal and abdominal complaints. Early antiviral treatment may improve maternal outcomes.

Authors+Show Affiliations

Department of Internal Medicine, State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA. taqwa1@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20498414

Citation

Miller, Andrew C., et al. "Novel Influenza A(H1N1) Virus Among Gravid Admissions." Archives of Internal Medicine, vol. 170, no. 10, 2010, pp. 868-73.
Miller AC, Safi F, Hussain S, et al. Novel influenza A(H1N1) virus among gravid admissions. Arch Intern Med. 2010;170(10):868-73.
Miller, A. C., Safi, F., Hussain, S., Subramanian, R. A., Elamin, E. M., & Sinert, R. (2010). Novel influenza A(H1N1) virus among gravid admissions. Archives of Internal Medicine, 170(10), 868-73. https://doi.org/10.1001/archinternmed.2010.126
Miller AC, et al. Novel Influenza A(H1N1) Virus Among Gravid Admissions. Arch Intern Med. 2010 May 24;170(10):868-73. PubMed PMID: 20498414.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Novel influenza A(H1N1) virus among gravid admissions. AU - Miller,Andrew C, AU - Safi,Farnaz, AU - Hussain,Sadia, AU - Subramanian,Ramanand A, AU - Elamin,Elamin M, AU - Sinert,Richard, PY - 2010/5/26/entrez PY - 2010/5/26/pubmed PY - 2010/7/7/medline SP - 868 EP - 73 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 170 IS - 10 N2 - BACKGROUND: Pandemic novel influenza A(H1N1) is a substantial threat and cause of morbidity and mortality in the pregnant population. METHODS: We conducted an observational analysis of 18 gravid patients with H1N1 in 2 academic medical centers. Cases were identified based on direct antigen testing (DAT) of nasopharyngeal swabs followed by real-time reverse-transcriptase polymerase chain reaction analysis (rRT-PCR) or viral culture. Patient demographics, symptoms, hospital course, laboratory and radiographic results, pregnancy outcome, and placental pathologic information were recorded. Results were then compared with published reports of the H1N1 outbreak and reports of flu pandemics of 1918 and 1957. RESULTS: Eighteen pregnant patients were admitted with H1N1 during the study period. All patients were treated with oseltamivir phosphate beginning on the day of admission. Mean (SD) age was 27 (6.6) years (age range, 18-40 years); median length of hospital stay was 4 days. Intensive care unit admission rate was 17% (n = 3). Demographically, 2 patients were health care workers (11%); 15 were black (83%); 2, Hispanic (11%); and 1, white (6%). None reported recent travel. Half of the patients presented with gastrointestinal or abdominal complaints; 13 patients met sepsis criteria (72%). The most common comorbidities were asthma, sickle cell disease, and diabetes. Fourteen patients tested positive for H1N1 on DAT (initial or repeated) (78%); in the other 4 cases, H1N1 was identified by viral culture or rRT-PCR (22%). Seven patients delivered during hospitalization (39%), 6 prematurely and 4 via emergency cesarean delivery. There were 2 fetal deaths (11%). No maternal mortality was recorded. CONCLUSIONS: Admitted pregnant patients with H1N1 are at risk for obstetrical complications including fetal distress, premature delivery, emergency cesarean delivery, and fetal death. A high number of patients presented with gastrointestinal and abdominal complaints. Early antiviral treatment may improve maternal outcomes. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/20498414/Novel_influenza_A_H1N1__virus_among_gravid_admissions_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2010.126 DB - PRIME DP - Unbound Medicine ER -