Swine Flu and the Prenatal Clinic

indigo girl · Jul 8, 2009

http://scienceblogs.com/effectmeasure/2009/07/swine_flu_and_the_prenatal_cli.php

A risk factor for swine flu complications is pregnancy. Yet one of the few venues specifically for healthy people in modern health care facilities is for pregnant and postpartum women, the in and out patient portions of the obstetrics department. And what of the newborn whose mother gets the flu? Infants are also at greater risk from influenza complications.
This is a tough problem. CDC has just issued some interim guidance regarding swine flu and obstetrics settings. The guidance is "interim" because CDC is quite frank that there is a great deal we don't know about the probabilities and severity of this virus in pregnant women. Still, some attempt to think this through is needed because the virus doesn't care how much we know and don't know. Here's a sketch of what they have come up with.
The underlying principle is to keep healthy people separated from those likely to be or possibly infectious. This means being able to identify sick patients, visitors or staff from those that aren't. If a pregnant woman hasn't been inclose contact with a known case of swine flu at home or at work, then they can be treated without special consideration. Those with identified exposure taking antivirals (Tamiflu or Relenza) for prophylaxis can be seen along with others but with standard infection control (presumably droplet precautions). But if they have an influenza-like illness (ILI; abrupt onset of fever greater than 100 degrees F., cough or sore throat, and no known other cause for the symptoms) they should be treated as if they have flu, even before testing. At this point they should be isolated from healthy women. This obviously means they should not be seen in the prenatal clinic until they are well (this isn't part in the guidance, but it is implied).

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