The effects of respiratory failure on delivery in pregnant patients with H1N1 2009 influenza.
BACKGROUND
The majority of hospitalizations for H1N1 complications have been in people with high-risk comorbidities, including pregnancy. Here we describe the obstetric and critical care treatment of three patients with confirmed H1N1 influenza virus infection complicated by acute respiratory failure.


METHODS
We describe the clinical and therapeutic courses of three patients with confirmed H1N1 2009 influenza virus infection complicating singleton, twin, and triplet gestations, each of which were complicated by respiratory failure.


CONCLUSIONS
These three cases illustrate that a high index of suspicion, prompt treatment, timing and mode of delivery considerations, and interdisciplinary treatment are integral to the care of pregnant patients with H1N1 influenza infections complicated by acute respiratory failure.
Jafari
Anahita
A
From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, and the Department of Anesthesia, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, California.
Langen
Elizabeth S
ES
Aziz
Natali
N
Blumenfeld
Yair J
YJ
Mihm
Frederick
F
Druzin
Maurice L
ML
D000328:Adult; D003422:Critical Care; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000628:therapy
Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009;361:1935–44.
Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451–8.
Saleeby E, Chapman J, Morse J, Bryant A. H1N1 influenza in pregnancy: a cause for concern. Obstet Gynecol 2009;114:885–91.
Faix DJ, Shermann SS, Waterman SH. Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans. N Engl J Med 2009;361:728–9.
Tanaka T, Nakajima K, Murashima A, Garcia-Bournissen F, Koren G, Ito S. Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women. CMAJ 2009;181:55–8.
Tomlinson MW, Caruthers TJ, Whitty JE, Gonik B. Does delivery improve maternal condition in the respiratory-compromised gravida? Obstet Gynecol 1998;91:108–11.
Jenkins TM, Troiano NH, Graves CR, Baird SM, Boehm FH. Mechanical ventilation in an obstetric population: Characteristics and delivery rates. Am J Obstet Gynecol 2003;188:549–52.
Lapinsky SE. Cardiopulmonary complications of pregnancy. Crit Care Med 2005;33:1616–22.
Kametas NA, McAuliffe F, Krampl E, Chambers J, Nicolaides KH. Maternal cardiac function in twin pregnancy. Obstet Gynecol 2003;102:806–15.