title: Pandemic (H1N1) 2009 virus infection during pregnancy in South India.
abstract: OBJECTIVE
  To assess the clinical profile of pregnant/puerperal women from a semi-urban Indian population who were infected with pandemic (H1N1) 2009 virus (P[H1N1]2009v) and to evaluate their outcome.
  
  
  METHODS
  In a cross-sectional study, 566 women (79 pregnant/puerperal, 487 nonpregnant) who presented to a tertiary care hospital with influenza-like illness were tested for P(H1N1)2009v by real-time reverse transcriptase polymerase chain reaction. Outcomes measures were the maternal mortality and the perinatal mortality rate (PMR).
  
  
  RESULTS
  Twenty (25%) pregnant/puerperal and 144 (30%) nonpregnant women tested positive for P(H1N1)2009v, with 5 pregnant and 3 postpartum women requiring admission to the intensive care unit (ICU). P(H1N1)2009v-related mortality was higher in pregnant than nonpregnant women (25% versus 8%; P=0.04). In the pregnant/puerperal cohort, factors associated with death included delayed presentation (median 6days versus 1.5days in survivors; P=0.007), need for ICU admission (P=0.004), need for ventilation (P=0.001), and renal failure (P=0.001). The PMR was 55.5/1000 births compared with 33.5/1000 births in the hospital overall during the study period.
  
  
  CONCLUSIONS
  In a low-income country, P(H1N1)2009v infection in pregnancy is associated with considerable mortality. Delayed presentation to a tertiary care center, lack of awareness, and restricted access to treatment might have contributed to the high mortality.
authors.affiliation: Department of Obstetrics and Gynecology Unit III, Christian Medical College Hospital, Vellore, India. angsumita@gmail.com
authors.forename: Angsumita
authors.initials: A
authors.lastname: Pramanick
authors.forename: Swati
authors.initials: S
authors.lastname: Rathore
authors.forename: John V
authors.initials: JV
authors.lastname: Peter
authors.forename: Mahesh
authors.initials: M
authors.lastname: Moorthy
authors.forename: Jessie
authors.initials: J
authors.lastname: Lionel
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008875:Middle Aged; D054238:Perinatal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000401:mortality; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013997:Time Factors; D055815:Young Adult