Master Class

Ob.Gyns. on the Front Line in the H1N1 Flu Pandemic


In the middle of an active influenza pandemic, the benefit of having an otherwise healthy woman at midgestation keep her routinely scheduled prenatal visit as opposed to deferring her visit and staying at home (possibly calling in to talk with a triage nurse) will need to be considered.

The alternatives are not perfect, but we certainly do not want to expose healthy pregnant women to a potentially lethal infection in our waiting room or even in the bus or elevator of our office building.

Our other challenge will involve hospital care. As obstetricians we will need to facilitate and lead the development of labor and delivery triage systems aimed at separating infected and noninfected laboring patients.


Pandemic H1N1 Flu and Pregnancy

Our nation is facing an influenza pandemic this fall and winter, adding to the difficulties of dealing with a struggling economy, two foreign wars, and attempts to reform our health care.

Indeed, on June 11, 2009, the World Health Organization announced that a pandemic of influenza A(H1N1) was underway. The U.S. count includes thousands of hospitalizations and more than 350 deaths to date.

Although most people who have become ill with this new virus have recovered without requiring medical treatment, there is great concern regarding the effects of this novel flu virus on vulnerable populations.

Seasonal influenza typically poses the greatest risk to the very young and the very old, but this influenza pandemic poses the greatest risk to young people and to pregnant women, in particular. High rates of severe illnesses and even deaths have been reported among pregnant women during this current outbreak. Thus, this pandemic has to be taken very seriously in obstetrics, and we need to employ all preventive measures possible. If we can do this effectively, we can head off the most significant and severe adverse consequences in our pregnant patients.

In an effort to provide the greatest education for the obstetrical community, and to create the greatest preparedness for managing the H1N1 pandemic, we have chosen to do a comprehensive Master Class on this subject. We have invited Mark Phillippe, M.D., M.H.C.M., to tell us how previous influenza pandemics have affected pregnant women and to discuss what impact the current pandemic is already having. We also have asked him to provide in detail his preparedness plan for practicing obstetricians.

Dr. Phillippe is John Van Sicklen Maeck Professor and Chairman of the department of obstetrics, gynecology, and reproductive sciences at the University of Vermont, Burlington. He is a nationally recognized maternal-fetal medicine expert, and has a research interest in influenza and how and why it impacts maternal mortality and the risk of pregnancy loss.

Key Points

The newly emerged pandemic influenza A(H1N1) virus is expected to present significant challenges to the entire health care system.

The challenges will be especially great for pregnant women and those who provide medical care for them.

Previous influenza pandemics have been notable for increased morbidity and mortality among pregnant women, especially during the third trimester.

In the past, all that could be offered to pregnant women was supportive care. We now have antiviral medications and will soon have a vaccine for the pandemic H1N1 virus.

We need to educate ourselves and our patients about how to use these therapeutic interventions effectively.

Source: Dr. Phillippe


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