Severe 2009 H1N1 infection in early pregnancy

Abstract

Objective: Because pregnancy suppresses the immune system, women at any stage of pregnancy are more susceptible to bacterial and viral infection. Pregnant women might thus be at increased risk of complications from pandemic H1N1 virus infection, and illness may progress rapidly. Case Report: A 23-year-old primigravida at 9 weeks’ gestation was presented to our institution because of the sudden onset of sore throat, fever, chills, and vomiting for 5 days. She was diagnosed with early pregnancy H1N1 infection, vulvar herpes infection, and impending intravascular disseminated coagulopathy. Oseltamivir (Tamiflu) 75 mg and valacyclovir 500 mg were then administered orally twice daily for 5 days. The patient’s fever, chills, and vomiting subsided 2 days later. The real-time reverse-transcriptase polymerase chain reaction (RT-PCR) analysis of nasal discharge for influenza virus types A and B showed positive results for the A/H1N1 influenza virus. The early pregnancy was terminated by therapeutic curettage at the patient’s request. The surgical specimen revealed products of conception with the presence of necrotic chorionic villi, and focal lymphocytes in decidual tissue. RT-PCR analysis of gestational tissue for A/H1N1 was negative. Conclusion: Pregnant women with H1N1 infection seem to benefit from antiviral therapy.

Keywords

• antiviral therapy
• H1N1 infection
• intravascular disseminated coagulopathy
• pregnancy