As indicated above, most of the respiratory complications have been shown to occur in the second and third trimesters. There may be situations where a preterm baby needs to be delivered in order to improve the outcome for ventilation of a very ill mother. The decision is made in conjunction with the obstetric, critical care and neonatal teams. The pregnant woman should be informed but if unable to participate in clinical decision making, the partner or close relatives should usually be involved in discussions. In order to improve the outcome for the premature infant, corticosteroids (in accordance with the guidance above) should ideally be administered at least 24 h prior to delivery. It is unlikely that pregnancies in the 1st or early second trimesters will need to be terminated unless it is felt that continuation of the pregnancy will be detrimental to the woman's condition. There may be occasions where a woman who is booked for elective caesarean section becomes symptomatic at the time of the planned procedure. If possible, it would be advisable to commence her on antivirals and to delay the procedure by about 5 days, to allow her to recover, in order not to increase her risks of respiratory complications, and also to reduce the risk of spread to other patients and staff. In severe cases of respiratory complications where the woman has developed Adult Respiratory Distress Syndrome (ARDS) and where she is not responding to mechanical ventilation, she may have to be considered for Extra Corporeal Membrane Oxygenation (ECMO). This is highly Be prepared to deal with: DIC, post viremia encephalitis Anti microbial therapy should be based upon bacteriological sensitivities-be cautious with the use of Augmentin in women with ruptured membranes