Author丨Li Yong Department of Respiratory Medicine of Suzhou Municipal Hospital
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Yimaitong Introduction
Every autumn and winter is the high season for influenza . Today, several pregnant women with fever came to the outpatient clinic, and they should consider the possibility of influenza. What are the dangers of flu in pregnant women?
complications
The main complications of influenza are as follows:
(1) Neurological system: encephalitis, meningitis, Green-Barre syndrome, etc.;
(2) Cardiovascular: pericarditis , myocarditis , etc.;
(3) Respiratory system: bronchitis, pharyngitis, pneumonia (primary viral inflammation, secondary bacterial pneumonia ), acute aggravation of chronic lung disease;
(4) Musculoskeletal system: myositis, rhabdomyolysis, etc.;
(5) Pregnancy: increased complications in pregnant women, increased perinatal mortality rate in neonatal period, miscarriage, low birth weight, etc.
(6) Changes in the immune system and cardiopulmonary function during pregnancy make pregnant women more likely to suffer from influenza. Moreover, pregnant women and pregnant women are more likely to suffer from complications after suffering from influenza within 2 weeks after delivery, progressing to severe influenza, prone to pneumonia, and rapid dyspnea, respiratory failure, ARDS and even multi-organ failure, with a high mortality rate, which can also lead to miscarriage, premature birth, fetal distress, and fetal death in the uterus.
So during the flu season, if pregnant women have fever and are suspected to be influenza, how should clinicians diagnose and treat them scientifically and standardize?
Diagnostic Process
Pregnant women with suspected influenza is perfectly tested, such as routine blood, CRP, influenza virus antigen or nucleic acid test, etc. The specific diagnosis and treatment process can refer to the 2018 American Society of Obstetricians and Gynecologists (ACOG) Committee's opinion "Evaluation and Treatment of Suspected or Confirmed Influenza in Pregnant Women" (Figure 1)
Figure 1 Evaluation and Treatment Process of Suspected or Confirmed Influenza Pregnant Women's Suspected or Confirmed Influenza
ACOG Process According to the symptom assessment, whether it is suspected influenza, and further evaluate the severity, whether there are comorbid diseases, obstetric problems, etc., and divide the suspected or confirmed influenza pregnant women into high, medium and low risks, and then determine the treatment place, and recommend antiviral treatment plans.
Notes
1. The best time window for antiviral treatment is within 48 hours of onset, but antiviral treatment can still benefit from more than 48 hours. Antiviral treatment can reduce symptoms and shorten the course of the disease, prevent the progression of severe influenza to a certain extent, and avoid complications such as pneumonia, respiratory failure and ARDS.
2. The first choice for pregnant women is oseltamivir . At present, most studies have confirmed its effectiveness and safety .
3. There is a risk of neonatal defects during pregnancy, and acetaminophen can be used to treat antipyretic treatment.
4. Influenza vaccination during pregnancy can not only protect pregnant women, but also reduce the risks of influenza, fever during pregnancy, preeclampsia , and premature placenta rupture, but also protect newborns who cannot receive influenza vaccine within 6 months of age from influenza through fetal transmission antibodies. WHO Influenza Vaccine Position Document (2012 Edition) lists pregnant women as the first priority vaccination population . China's Influenza Vaccination Guidelines (2019-2020) recommends that pregnant women or women who are preparing for pregnancy during the flu season get influenza vaccine, and pregnant women can get at any stage of pregnancy.
Summary
1. Pregnant women have high influenza incidence and mortality rates, and it is recommended that pregnant women get influenza vaccination;
2. Early identification of influenza-like symptoms, correctly assess the severity, and prescribe safe and effective antiviral drugs (see Figure 1);
3. Pregnant women do not need to wait for test results for suspected influenza. Antiviral treatment should be initiated as soon as possible after evaluation and clinical diagnosis. Oseltavir is the first choice.
References
1. National Health Commission of the People's Republic of China. Influenza Diagnosis and Treatment Plan (2019 Edition).://www.nhc.gov.cn/yzygj/s7653p/201911/a577415af4e5449cb30ecc6511e369c7/files/75a810713dc14dcd9e6db8b654bdef79.pdf
2.ACOG Committee Opinion No. 753:Assessment and Treatment of Pregnant Women With Suspected or ConfirmedInfluenza. Obstet Gynecol. 2018 Oct;132(4):e169-e173.
3. Emergency Physicians Branch of the Chinese Medical Association, Emergency Medicine Branch of the Chinese Medical Association, Emergency Medicine Professional Committee of the People's Liberation Army of China, Key Laboratory of the Ministry of Education for Emergency and Trauma Research. Consensus of Emergency Experts in the Diagnosis and Treatment of Influenza in China [J]. China Emergency Medicine, 2019, 39(10):915-928.
4. CDC. Pregnant Women Influenza (Flu). https://www.cdc.gov/flu/highrisk/pregnant.html
5.World Health Organization.Vaccines against influenza WHO position paper - November 2012[J]. WklyEpidemiol Rec, 2012, 87(47): 461-476.
6. China Center for Disease Control and Prevention. Technical Guidelines for Influenza Vaccination in China (2019-2020).://www.chinacdc.cn/jkzt/crb/bl/lxxgm/jszl_2251/201910/W020191017382174982602.pdf
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