Management of pandemic (H1N1) 2009 virus infection during and following pregnancy, childbirth, and postnatal care

 

 

The clinical management of pregnant women infected with pandemic (H1N1) 2009

 Virus includes management of influenza18 and care specific to pregnancy, childbirth,
and the postnatal period.15,19


 Management of influenza during pregnancy

 

 

The following points are to be considered during pregnancy:

 

• Pregnant women who meet the current case definition for uncomplicated

illness with confirmed or suspected pandemic (H1N1) 2009 virus should be
treated early with the antiviral medications oseltamivir or zanamivir. The
regimen is the same as the regimen for other adults. Treatment is for five days.

 

• Treatment with antiviral medications should begin as soon as possible and

without waiting for results of diagnostic testing. A negative laboratory test
should not stop treatment in a patient with clinical suspicion of influenza.

 

• Patients who have severe or progressive clinical illness should be treated with

oseltamivir. This recommendation applies to all patient groups, including
pregnant women. Currently, there are no data supporting administration of
oseltamivir in doses higher than 75 mg twice daily for pregnant women.

 

• Danger signs that can signal progression to more severe disease in pregnant

women are the same as in other patients (i.e. shortness of breath either during
physical activity or while resting, difficulty in breathing, turning blue, bloody or
coloured sputum, chest pain, altered mental state, high fever that persists
beyond three days, and low blood pressure).

 

• Fever (>38° C) in early pregnancy is associated with increased risk of fetal

anomalies and, in late pregnancy, with adverse perinatal outcomes. Treat fever
associated with pandemic (H1N1) 2009 virus infection in pregnant women or
women in labour or breastfeeding with paracetamol (acetaminophen).

 

• Explain the importance of adequate nutrition and fluid intake to the woman

and her family.

• Prophylactic antibiotics are not recommended.

• Co-infections must be treated early. Ensure that antimicrobials for treating any

co-infections are safe for use during pregnancy and lactation.19

• If oxygen is required for severe pneumonia, ensure that oxygen saturation

(SaO2) remains above 92-95%.

Management of influenza during and following childbirth

Women with pandemic (H1N1) 2009 virus infection face a higher risk of preterm

labour and delivery.

• Balance the advantages of use of tocolysis with potential harm related to

tachycardia, hypotension, or other side effects.

• Corticosteroids for promotion of fetal lung maturation in suspected preterm

labour or for anticipated preterm labour are safe, when used at therecommended dose for this indication.19

• If a woman has an infection with pandemic (H1N1) 2009 virus, there is a higher

risk of fetal distress and increased risk of operative delivery.

• Balance the risk of operative vaginal delivery with the risk of caesarean delivery

and anaesthesia in a severely ill woman.

Newborn care

• Keep ill babies with their mothers.

• If the mother is ill with influenza, she should follow measures to prevent

transmission. These include covering coughs and sneezes when caring for and
breastfeeding the baby, as well as performing frequent hand hygiene.

• Mothers should be encouraged to initiate breastfeeding within one hour o

giving birth and to breastfeed frequently and exclusively.

• The mother can continue breastfeeding, even if she is ill and on antiviral

medicines. She should take additional fluids, especially if she has fever.

• If severe maternal illness prevents the mother from feeding the infant at her

breast, she should be helped to express her breast milk and feed it to the infant

by cup or cup and spoon.

• Data on treatment of newborn infants with pandemic (H1N1) virus infection

are limited. However, newborn infants with severe or deteriorating illness

should be treated with antivirals. Give oseltamivir 3 mg/kg/dose once daily for
5 days to newborn infants younger than 14 days. For older infants, giveOseltamivir 3 mg/kg/dose twice daily for five days.11

• Ensure that newborn infants are not given any medications for prophylaxis or

treatment, including paracetamol (acetaminophen) for fever, without medical
advice. Acetylsalicylic acid (aspirin) should be avoided because of the risk of
Reye’s syndrome.