Skret-Magierło Joanna, Florek Agnieszka, Skret Andrzej, Piechota Zenon, Botiuk Krzysztof, Pajak Mareks, Kokot Piotrs
Kliniczny Oddział Ginekologii i Połoznictwa, WSS Rzeszów.
Ginekol Pol. 2010 Mar;81(3):227-31.
Pregnant women, just like the rest of the population, are at risk of the novel A/H1N1 infection. However, since they belong to a more susceptible group of patients, the risk of a severe course of the disease is significantly higher when compared to their non-pregnant counterparts. This risk is especially great when the infection is accompanied by chronic conditions such as asthma or diabetes mellitus, resulting in an increased morbidity and mortality of both the mother and the fetus.
The aim of the study was to present the first four cases of A/H1N1 infection in advanced pregnancy in Podkarpacie Province of Poland that were noted in the course of six weeks in November and December 2009.
Maternal age ranged between 27 to 34 years, gestational age was between 29 to 38 weeks. One patient had been at first admitted to Infectious Disease Clinic, and later on transferred to the Intensive Care Unit due to respiratory distress syndrome. The remaining three patients were hospitalized in the obstetrical unit, two of them due to respiratory tract infection and one due to amniotic fluid leakage without any respiratory failure symptoms. Three patients required artificial ventilation. One patient delivered vaginally, and the remaining three had caesarean section, one of them had an emergency c-section in agonia. The fatal outcome in this patient was the result of improper diagnosis due to a false negative stripe-test result. In case of the other three patients, properly diagnosed with Real Time RT-PCR test, an immediate antiviral therapy was introduced. Two neonates died: one delivered by the woman in agonia, and one due to intrauterine hypoxia and prematurity
Diagnostic and therapeutic difficulties in A/H1N1 infections in pregnant women may have their source in that fact that an unreliable stripe test alone is used (without confirmation of the infection with Real Time RT-PCR), risk factors are not taken into the account and antiviral therapy is delayed or postponed. Early antiviral therapy and delivery in case of respiratory distress syndrome improve the prognosis for both the mother and the child.
孕妇与其他人群一样，有感染新型甲型H1N1流感的风险。然而，由于她们属于更易感的患者群体，与未怀孕的同龄人相比，患重症疾病的风险显著更高。当感染伴有哮喘或糖尿病等慢性疾病时，这种风险尤其大，会导致母亲和胎儿的发病率和死亡率增加。
本研究的目的是介绍2009年11月和12月六周内波兰喀尔巴阡省晚期妊娠中首例四例甲型H1N1流感感染病例。
产妇年龄在27至34岁之间，孕周在29至38周之间。一名患者最初入住传染病诊所，后来因呼吸窘迫综合征转入重症监护病房。其余三名患者在产科病房住院，其中两名因呼吸道感染，一名因羊水渗漏且无任何呼吸衰竭症状。三名患者需要人工通气。一名患者顺产，其余三名进行剖宫产，其中一名在濒死状态下进行了急诊剖宫产。该患者的死亡是由于试纸检测结果为假阴性导致诊断不当。对于其他三名经实时逆转录聚合酶链反应检测确诊的患者，立即进行了抗病毒治疗。两名新生儿死亡：一名由濒死状态的妇女分娩，另一名因宫内缺氧和早产死亡。
孕妇甲型H1N1流感感染的诊断和治疗困难可能源于仅使用不可靠的试纸检测（未通过实时逆转录聚合酶链反应确认感染）、未考虑风险因素以及抗病毒治疗延迟或推迟。对于呼吸窘迫综合征患者，早期抗病毒治疗和分娩可改善母婴预后。
