A PATHBREAKING TREATMENT CASE BY SIR GANGA RAM HOSPITAL TEAM -PREGNANT MOTHER AND CHILD SURVIVE DEADLY SWINE FLU
MOST CHALLENGING CASE OF H1N1 (SWINE FLU) SURVIVAL
PREGNANT MOTHER AND CHILD SURVIVE DEADLY SWINE FLU
A MOST DIFFICULT MEDICAL CHALLENGE, SUCCESSFULLY OVERCOME!
Pregnant women are more prone to severe forms of swine flu which are much more life threatening to both mother as well as fetus . The complications in these cases are very difficult to control.
According to Centers for Disease Control and Prevention , “ A study conducted during the first month of the outbreak found that the rate of hospitalizations for 2009 H1N1 was four times higher in pregnant women than the rest of the population. A higher proportion of ICU admissions and deaths occur in the second and especially third trimester . Of the 266 of the 305 U.S. swine flu deaths reported as of July 29, 2009 , fifteen — about 6% — were among pregnant women. Most of the deaths were among women in their third trimester “ .
A 28 years old female who was 29+ weeks pregnant was referred to Department of Chest Medicine , Sir Ganga Ram Hospital on 28thJanuary 2015 . She was brought in with a short history of fever with chills , cough and progressive breathlessness since last 4 days . Her X-Ray showed bilateral pneumonia . Her oxygen saturation levels were critically low requiring very high oxygen support. Tamiflu was started at the time of admission due to high clinical suspicion . Her H1N1 RTPCR was positive upon evaluation .
According to Dr Arup Basu , Chairperson , Department of Chest Medicine , Sir Ganga Ram Hospital , “ Given her third trimester of pregnancy , her positive H1N1 status put us in a challenging situation and dilemma. The dilemma was how to save both mother and child . The child was still premature for delivery but since oxygen levels of mother were already at critical levels therefore the child inside the womb was oxygen deprived . On the other side , a delivery before 32 weeks would have meant high risk to the baby’s life. “
Seeing the severity of the case , a team was made of doctors from departments of Chest Medicine , Obs. & Gynae , Pediatrics , Neonatology and Critical Care consisting of 15 doctors and paramedical staff who took a collective decision that the only way to make both survive was to deliver the baby as soon as possible but the problem was of child’s under developed lungs .
To overcome this problem , special treatment ( steroids) were given to enhance the child’s under developed lungs . But this was also risky . The steroids carried the risk of increasing the lung problems in mother by way of secondary sepsis . This was tackled by giving appropriate anti-microbial cover to the mother . After this , Misoprostol (special medicine ) was given to mother to induce the delivery .
Our efforts were successful and a healthy 1345 grams baby was born on 29th January 2015 at 08:20 am .
Now the challenge was to save the mother .
According to Dr Geeta Mediratta , Sr. Consultant , Department of Obstetrics & Gynaecology , Sir Ganga Ram Hospital , “During pregnancy , the women are already immuno-suppressed and any viral infection specially H1N1 , can result in much magnified effect on the mother as well as the fetus . Various changes that occur in the body during pregnancy makes pregnancy a high risk group for complications due to H1N1 infection. .”
Dr Geeta further added , “ In pregnant women who are infected with H1N1, they can rapidly develop a haemodynamic (blood pressure , pulse rate etc ) imbalance, which acutely affects lung function and facilitates the development of pneumonia, acute pulmonary oedema( flooding of lungs with water ) , and other serious respiratory illnesses. Pregnancy also reduces the ability of women to tolerate hypoxic stress (low oxygen) , and thus increases risk of maternal and perinatal mortality.”
The mother was already into adult respiratory distress syndrome and respiratory failure. She was resuscitated with non-invasive ventilator and high oxygen. She also developed complications of secondary sepsis deep vein thrombosis which were tackled with antibiotics, blood thinners and other supportive therapy. Both mother and child are presently recovering well and would be discharged shortly.
Dr Basu further added, “Flu can be largely prevented for pregnant women and their babies, if they take vaccination . The vaccine is not a live vaccine and it cannot give you flu . It is considered absolutely safe during pregnancy .”
According to Dr Sumit Ray , Vice-Chairperson , Department of Critical Care , Sir Ganga Ram Hospital , “Since there is no medicine for swine flu except tamiflu which also is not very effective , therefore the critically effected H1N1 patients are subjected to special critical care techniques including special positions like PRONING for ventilatory support . These patients are put on tummy while on ventilator and not on back .”