A(H1N1) and the pregnant woman


As of Aug 12, 2009, there have been 44 deaths in the country related to the Influenza A(H1N1). Among the recent deaths are a 10-month-old girl, a one-year-old boy and an 18-year-old pregnant woman.

According to the Ministry of Health, those in the high-risk group are:

- Children younger than 5 years old;
People aged 65 years and older;
- Children and adolescents (below 18 years) on long-term aspirin therapy;
- Pregnant women;
- Adults and children with asthma, chronic obstructive pulmonary disease, organ failure, cardiovascular disease, hepatic, heamatological, neurologic, neuromuscular or metabolic disorders such as Diabetes Mellitus;
- Adults and children who have immunosuppression; and
- Residents of nursing homes and other chronic care facilities.

What are the A(H1N1) symptoms?

- Fever
- Cough
- Sore throat
- Body aches
- Chills
- Vomiting and diarrhoea in some cases.

According to WHO (the World Health Organisation), the danger signs that signal the progression of the A(H1N1) flu are:

- Shortness of breath, either during physical activity or while resting
- Difficulty in breathing
- Turning blue
- Bloody or coloured sputum
- Chest pain
- Altered mental status
- High fever that persists beyond 3 days
- Low blood pressure.

In children, the danger signs are:

- Fast or difficult breathing
- Lack of alertness
- Difficulty in waking up
- Little or no desire to play

Dr Gunasegaran.
Dr Gunasegaran
PT Rajan, obstetrician and gynaecologist, answers some questions on A(H1N1) and the pregnant woman.

Why are pregnant women in the high risk group?

Pregnant women are in the high risk group because of altered immunity so they are more prone to getting viruses, not just A(H1N1) but any virus. The virus itself is unknown so we are not sure why it seems to be attacking some people more than others. Then there is the foetus – that's another reason why the pregnant woman is at higher risk.

What sort of symptoms should the pregnant woman be concerned about?

Among the many symptoms, the fever is one of those that can be potentially disastrous for pregnant women. High fevers can pose problems – they could have a miscarriage, they can go into premature labour, it can result in deformities in the baby, cause cerebral palsy in the baby or have a poor outcome at birth. This is if they are still pregnant when they have the fever.

The first priority is to control the fever when they are pregnant. Babies can go into distress. On the mother's side, the complications are very similar to somebody who is not pregnant which is chest congestion, pneumonia and acute respiratory distress syndrome.

What sort of precautions should a pregnant woman take?

Precautions that pregnant women can take are the same as those taken by everyone else:

- Avoid crowded places
- Avoid contact with anybody who is potentially at risk and those who have been expos
- Avoid going to high risk places
- Wash your hands
- Have proper nutrition and ensure you're taking their vitamins and plenty of fluids
- Work from home if possible

Even the regular clinic visits we are now advising them if they are low risk pregnancies, they can do it every three weeks instead of every two weeks. Some of the consultations can even be done via phone or email for those with low risk pregnancies.

What happens to a pregnant woman who has the Influenza A(H1N1)?

We have to be very careful. Especially in the first trimester when organogenesis occurs, the baby's organs are being formed so we have to be a bit more careful. If somebody gets fever, H1N1, they are given paracetamol to bring down the fever and they should take lots of fluids.

The trend now is that the minute you are diagnosed, within two days, don't wait, get treated. If you're admitted the doctors at hospital will treat you anyway, but if you're at home and having sore throat and other flu symptoms plus fever for two days, get treated at any hospital. If there are flu symptoms but no fever, that's probably okay.

Ideally, if you have flu symptoms for a day, you monitor. If it's two days, you should do a throat swab test. The swab test results will tell you if it's flu A or B. If it's flu A it may or may not be H1N1.

The test that they're doing everywhere now is the first line of screening.

If it's flu A, you need to send another sample to IMR (Institute of Medical Research) to confirm and while waiting for that, you will get treated.

If they're in the third trimester and they get the A(H1N1) flu we are more likely to deliver the baby. We want to act fast and not risk it.

What if the pregnant woman is fine but her husband or children have the Influenza A(H1N1)?

We sometimes give prophylaxis for prevention. This is for those who don't have symptoms but they have been exposed, they're living with somebody who has H1N1. They too should come forward to be tested.

Are all these anti-viral drugs safe for the unborn baby?

When we give drugs to the mother we have to think twice what it will do to the child. These drugs – Tamiflu and Relenza – are largely unknown in long-term studies. However, current evidence does not say that there are any serious defects. There is greater benefit than harm to the baby.

Is the pregnant woman still at risk after delivery?

If a woman is post delivery, she is still potentially at risk as those who are pregnant. If they get A(H1N1) in post delivery they can continue breastfeeding and they should continue breastfeeding. There is the question of whether they will pass on the flu to their baby. During breastfeeding the mother's antibodies are passed on to the baby, so breastfeeding should be continued but observe the same hygiene – wear a mask, wash your hands all the time, minimise contact, don't share the toys among the children in the family, isolate yourself and the baby from the other family members.

A(H1N1) is serious. It's not just a lot of hype. The good news is it's not as deadly as SARS (Severe Acute Respiratory Syndrome) but the rate of spread is much faster.


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