Swine flu: case reports of 3 pregnant women http://scienceblogs.com/effectmeasur...ts_in_3_pr.php
The Reveres commentary on the pregnant cases presenting with S-OIV is interesting. They explain why pregnancy is a risk factor. The thinking on the use of Tamiflu and Relenza in pregnancy is useful.
Patient A is the woman who died. Again, there is no mention of RA as one of her pre-exising conditions. The baby, borne via C-section was healthy.
Quote from scienceblogs.com
On April 19, an emergency cesarean delivery was performed, resulting in a female infant with Apgar scores of 4 at 1 minute after birth and of 6 at 5 minutes after birth; the infant is healthy and has been discharged home.
Flu can be a nasty illness, nasty enough to kill you. Pregnant women are at more risk than others because their physiology is altered. They are carrying a foreign body (the fetus) so their immune response is not the same, and their cardiovascular and respiratory physiology are also different. CDC is reporting about 20 swine flu cases in pregnant women, and late yesterday they gave a more detailed description of three cases, one of which ended fatally:
Patient C's obstetrician was also pregant (13 weeks) and she was started on oseltamivir immediately. So far the swine flu virus is sensitive to the neuriminidase inhibitor antivirals, oseltamivir (Tamiflu) and zanamivir (Relenza), but oseltamivir is recommended for pregnant women because it is absorbed systemically. The oseltamivir tablet is not the active form of the drug but a "pro-drug" designed to be absorbed in the gastrointestinal tract. Once in the blood it is converted to the active form by enzymes in the liver. Zanamivir is already in the active form but cannot be absorbed. It is administered with an inhaler, so only affects virus in the respiratory tract. CDC believes it is preferable to get the drug to other organs, including the placenta.
Do we know that oseltamivir is safe for the fetus? No good safety studies have been done, but what evidence exists does not suggest risk to the fetus. Given the risk of influenza, CDC believes the risk-benefit balance nets out in favor of 5 days of oseltamivir use in pregnant women as early in their illness as possible.
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.