FOR HIGHLY PATHOGENIC INFLUENZA A(H1N1) IN PREGNANCY AND IMPACT ON BIRTH OUTCOMES
Authors: Avdeeva M. G , Gafurova O. R 
Published: March 2020

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.