title: Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report.
abstract: OBJECTIVE
  To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey.
  
  
  METHODS
  A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection.
  
  
  METHODS
  Nationwide in Turkey.
  
  
  METHODS
  Thirty-six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection.
  
  
  METHODS
  Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009.
  
  
  METHODS
  Maternal mortality as a result of H1N1 virus infection.
  
  
  RESULTS
  The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one-fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause-specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77-5.43).
  
  
  CONCLUSIONS
  Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause-specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.
authors.affiliation: General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey, Ankara, Turkey. fsdede@yahoo.com
authors.forename: F S
authors.initials: FS
authors.lastname: Dede
authors.forename: S
authors.initials: S
authors.lastname: Celen
authors.forename: S
authors.initials: S
authors.lastname: Bilgin
authors.forename: G
authors.initials: G
authors.lastname: Ure
authors.forename: A O
authors.initials: AO
authors.lastname: Ozcan
authors.forename: T
authors.initials: T
authors.lastname: Buzgan
authors.forename: R
authors.initials: R
authors.lastname: Kose
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000401:mortality*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D011645:Puerperal Infection; D014421:Turkey / Q000453:epidemiology