孕产妇合并甲型H1N1流感对母儿结局的影响

Influence of maternal H1N1 influenza on perinatal outcomes

目的探讨孕产妇合并甲型H1N1流感（简称甲流）对母儿结局的影响及产科处理。方法收集2009年11月7日至2009年12月15日中国医科大学附属盛京医院收治的19例合并甲流的孕产妇资料，回顾性分析甲流对母儿的影响。结果19例患者中，产褥期妇女3例，占15．8％，均为轻症，愈后良好。孕期患者16例，占84．2％，其中早期妊娠2例（12．5％），中期妊娠7例（43．8％），晚期妊娠7例（43．8％）。16例孕期患者按病情严重程度分，轻症6例（37．5％），重症2例（12．5％），危重症8例（50．0％）。2例早期妊娠患者均为轻症，甲流治愈后选择人工流产；中期妊娠的4例轻症患者甲流治愈后足月分娩，3例重症及危重症患者中1例甲流治愈后足月分娩，1例孕27周胎死宫内和1例孕23周因孕妇发生严重并发症，均行剖宫取胎术，后者胎儿娩出后死亡；妊娠晚期的7例均为重症及危重症患者，均行急诊剖宫产术终止妊娠，2例胎儿孕晚期胎死宫内，余5例存活，包括4例早产儿和1例足月儿。行急诊剖宫产手术的全部9例（56．3％，9／16）重症及危重症孕妇中，活产新生儿6例，存活的5例均未感染甲流；2例孕产妇术后死亡（10．5％，2／19）。结论妊娠晚期孕妇感染甲流极易发展为重症及危重症，及时终止妊娠是挽救母儿生命又使新生儿避免甲流病毒感染的有效方法之一。

Objective To discuss the influence olr H1N1 influenza on maternal and fetal outcomes and obstetric management. Methods Totally, data were collected on 19 women, affected by H1N1 influenza and admitted to Shengjing Hospital of China Medical University from November 7, 2009 to December 15, 2009, and retrospective analysis was performed on the maternal and fetal outcomes. Results Among the 19 cases, three were（15. 8%, 3/19） in puerperium, who were all mild cases and recovered. Sixteen （84.2%, 16/19）women were diagnosed as H1N1 influenza during pregnancy, among which two in early pregnancy （12. 5%）, seven （43. 8%） in mid term pregnancy and seven （43. 8%） in late pregnancy. According to the severity of HIN1 influenza, six were mild cases （37.5% ,6/16）, two （12.5% ,2/16）were severe cases and eight （50.0%, 8/16）were critical. For these 16 pregnant women, the two cases in early pregnancy （mild cases） were terminated after recovery from H1N1 influenza. Among the seven mid term cases, four mild and one of the three severe and critical cases delivered till term, and two of the three severe and critical cases were delivered abdominally because of fetal death intrauterine or maternal severe complications at 27 or 23 weeks of gestation. All of the seven late pregnant cases underwent emergent cesarean section due to maternal or fetal reasons, and two fetuses died in the uterus at late pregnancy and five survived including four preterm babies and one full term baby. Altogether, nine cases （56. 3%, 9/16） underwent emergent cesarean section, and six babies born alive and five survived without any symptom of influenza, two women died （10. 5 %, 2/19） after the operation. Conclusions Pregnant women during late pregnancy infected by H1N1 influenza are susceptible to develop into severe and critical conditions. Termination of the pregnancy in time is effective in both life-saving of the mothers and babies and prevent neonatal infection against H1N1.