Fatal prognosis of H1N1 influenza in late trimester of pregnancy: Descriptive analysis of four cases

Influenza infection in late trimester associated with complications is attributable risk factors for critical illness among pregnant women. We have analyzed the medical records of four pregnant women retrospectively who were admitted in a medical intensive care unit of tertiary care center with influenza-like symptoms of breathlessness, fever, headache, myalgia and cough. Their mean age was 26. 5 (19-30). They were confirmed to have H1N1infection by real-time reverse transcriptase polymerase chain reaction assay. Chest x-ray of all patients showed abnormalities like pulmonary edema and suggestive of acute respiratory distress syndrome. Arterial blood gas analysis of all four patients shown severe hypoxia and all of them was mechanically ventilated. Oseltemivir was started for all four from the day of admission. Pipracillin-tazobactum combination along with other antibiotics was given as prophylaxis and treatment of different infections. Midazolam and morphine were given together to reduce the restlessness and ventilator-associated distress. Furosemide was given to all for breathing problems and pulmonary edema. Despite of all the management provided none of the patients survived due to the progression of H1N1 into septic shock and multiple organs dysfunction syndromes.