New Delhi: A 28-year-old woman, who was suffering from swine flu and was on ventilator support, has delivered a healthy baby at a city hospital here.
Both their lives were at risk when the mother became critically ill with swine flu while seven months pregnant and referred to Sir Ganga Ram Hospital on January 25.
She was brought in with a short history of fever with chills, cough and progressive breathlessness since last 4 days and her X-Ray showed bilateral pneumonia. Her oxygen saturation levels were critically low requiring very high oxygen support. Her samples tested postivive for H1N1 (swine flu) virus, and she was put on Tamiflu.
"It was a challenging situation before us -- how to save both the 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, delivery before 32 weeks would have meant high risk to the baby's life," said Dr Arup Basu, Chairperson of Department of Chest Medicine at Sir Ganga Ram Hospital.
A team of doctors 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.
"Special treatment (steroids) was given to enhance the child's under developed lungs. 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, medicines were given to mother to induce the delivery and a healthy baby was born on Jan 29," said Basu.
The next challenge was to save the mother.
"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 and blood thinners.
Both mother and child are presently recovering well and would be discharged shortly," said Dr Geeta Mediratta, Sr Consultant at Department of Obstetrics and Gynaecology in the hospital.
According to Dr Geeta, during pregnancy, women are already immuno-suppressed and any viral infection specially H1N1 infection can result in much magnified effect on the mother as well as the fetus.
"Swine flu affected pregnant women 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 mortality," explained Dr Geeta.
Experts at the hospital urged all mothers-to-be to have the H1N1 vaccination as it is considered absolutely safe during pregnancy.
"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," said Dr Sumit Ray, vice-chairperson of Department of Critical Care.
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.