[Clinical features of severe new influenza A (H1N1) in pregnant women].

OBJECTIVE

To investigate the clinical characteristics of severe influenza A (H1N1) in pregnant women.

METHODS

Sixteen patients with severe pneumonia caused by influenza A (H1N1) were included in this study from November 26 to December 20, 2009.

RESULTS

All of the sixteen patients were young women, and 15 of them were pregnant. Leukopenia was observed in 2 cases of the 16 patients, and lymphopenia in 14 cases. Data on the ratio of CD(4) cells to CD(8) cells were available for 12 patients, and 7 cases of whom had an abnormal CD(4)/CD(8) ratio (< 1.4). Eleven of the 15 patients had increased serum lactate dehydrogenase levels, which were above 245 U/L. Three patients had elevated creatine kinase levels at admission. Five cases of the 16 patients had decreased serum potassium levels, which were below 3.5 mmol/L. Four patients had C(4) levels greater than 36 mg per deciliter, and 4 cases had C(3) less than 75 mg per deciliter. All 16 patients had radiologically confirmed pneumonia with bilateral patchy alveolar opacities, affecting 3 or 4 lung quadrants. Findings on chest radiographs were consistent with acute respiratory distress syndrome in all patients requiring mechanical ventilation. A small amount of pleural effusion was found in 4 cases, and pericardial effusion was found in 1 of them. Respiratory distress requiring intubation and mechanical ventilation developed in 9 pregnant patients within the first 24 hours after admission, and 2 of them in the third trimester died, while 7 patients for whom pregnancy was timely terminated recovered.

CONCLUSIONS

Pregnant women with 2009 pandemic influenza A (H1N1) appear to have an increased risk of severe disease characterized by severe pneumonia and respiratory failure. Early anti-viral therapy, early termination of pregnancy, and timely mechanical ventilation may bring clinical benefits to pregnant patients.