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30-year-old pregnant woman with swine flu in Delhi successfully treated

30-year-old pregnant woman with swine flu in Delhi successfully treated
Both the mother and the foetus have survived and are now healthy ©Shutterstock (Representational image)

The case was critical and complex as the foetus had to be protected from the virus while in the womb. Additionally, there was a risk of the mother developing bleeding complications and losing the unborn child. Both the mother and the baby are healthy now.

Written by Editorial Team |Updated : February 11, 2019 4:18 PM IST

Doctors at Fortis Escorts Heart Institute (FEHI), Okhla, New Delhi, treated a 30-year-old pregnant woman who had tested positive for swine flu (H1N1 virus). The case was critical and complex as the foetus had to be protected from the virus while in the womb. Additionally, there was a risk of the mother developing bleeding complications and losing the unborn child. A team of doctors, led by Dr Vineeta Goyal, Senior Consultant, Critical Care Department took on this high-risk case and treated the patient successfully through ECMO (Extracorporeal Membrane Oxygenation). In Delhi, the total number of people affected by swine flu this year (till the first week of February) was around 1,196, according to the Directorate General of Health Services.

Case study of the pregnant swine flu patient

The patient was 24 weeks pregnant when she was presented to the hospital with fever, persistent cough and shortness of breath. Her symptoms had worsened over the course of a day and her blood oxygen levels were extremely low. Her breathing became progressively laboured and she had to be immediately put on ventilator support. However, her condition continued to deteriorate. When the predicted chances of survival for both the mother and child fell considerably, the patient s family was given the option for ECMO (Extracorporeal Membrane Oxygenation) machine which acts as a heart-lung bypass. It can support and perform the functions of the lung and the heart, individually and together. Dr Vineeta Goyal, Senior Consultant, Critical Care Department, Fortis Escorts Heart Institute said, Complications, both maternal and foetal, were explained to the family. These included bleeding, intrauterine foetal death and spontaneous abortion. Within one hour of ventilation, ECMO was instituted. There was an immediate improvement in the blood oxygen levels of the patient. Since she had tested positive for the H1N1 virus, we had to treat her with antivirals such as oseltamivir ."

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The doctor explained that a gynaecologist was consulted on regular basis and repeated ultrasounds were done to ensure foetal wellbeing. After fifteen days, the patient was successfully weaned off ECMO and her foetus was alive and thriving. She was soon discharged. "The key to success is early referral to an ECMO centre," said Dr Vineeta.

Dr Kousar Ali Shah, Zonal Director, Fortis Escorts Heart Institute said, This case-- of a pregnant swine flu patient was a challenging case, fraught with complications and risks. The possibility of survival was extremely low. Putting the patient on ECMO was a sound and thought-out decision. Swine flu is an epidemic which is increasing at an alarming pace. If one feels even the slightest hint of infection they should get themselves tested immediately.

The ECMO circuit acts as an artificial heart and lung for the patient during ECMO therapy. It can be used in patients of all ages. ECMO continues until the underlying cardiac or lung problem is improved or resolved. The typical course is around five days, but in some cases, ECMO support can be continued for up to 25 to 30 days.

What is swine flu?

Swine flu, commonly known as H1N1 virus, has three categories A, B and C. While A and B categories need home care, category C requires immediate hospitalization and medical intervention as its symptoms and outcomes are extremely severe and could result in death. One should watch out for the primary influenza symptoms: high temperature, runny nose, cough, headache, muscle and joint pain. Precautionary measures should include the use of face masks and hand sanitizers. Additionally, if the fever does not subside within 24 to 48 hours, medical counsel should be sought.