Infectious Diseases in Obstetrics and Gynecology / 2015 / Article / Tab 1

Review Article

Influenza and Pregnancy: A Review of the Literature from India

Table 1

Characteristics of included studies.

Author (year)ObjectiveRegionSettingSamplePeriodOutcomesResults

1Mathur et al.
(2013) [37]
To assess the clinical profile, factors determining the response, prognosis of the disease, and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemicJodhpur
(West India)
ICU/isolation patients
Overall population: 221
Pregnant women: 37
2009-2010 Clinical and epidemiological characteristicsPrevalence of Influenza virus:
(i) Influenza A (pH1N1): 37 (23.4%)
Length of pregnancy at presentation:
(i) First trimester: 4 (11%)
(ii) Second trimester: 18 (49%)
(iii) Third trimester: 15 (40%)
Maternal mortality:
(i) 26 (70%) pregnant women died
(ii) Mortality in third trimester: 80%
(i) All patients received Oseltamivir, Zanamivir, oxygen and ventilatory therapy, intravenous antibiotics and fluids, low dose steroids, and symptomatic therapy according to WHO guidelines

2Mehta et al.
(2013) [38]
To observe clinical profile of admitted patients with confirmed H1N1 swine flu infection and risk factors associated with the need of mechanical ventilation and/or deathKochi, Kerala
(South India)
Overall population: 115
Pregnant women: 6
August 2009 to December 2011
(28 months)
Clinical and epidemiological characteristic
Risk factors associated
with mechanical ventilation/death
Influenza virus prevalence:
(i) Influenza A (H1N1): 5.2%
Maternal mortality: 2 women (33%)
Loss of fetus: 2 women (33%)
Preterm delivery: 2 women (33%)
All patients received Oseltamivir 75 mg twice daily for 5–10 days as per CDC guidelines

3Ramakrishna et al.
(2012) [36]
To detail the profile and outcomes of patients admitted to the intensive care unit (ICU) with pandemic Influenza A (H1N1) 2009 virus [P(H1N1)2009v] infectionBangalore, Vellore, Manipal
(South India)
ICU patients
Overall population: 1902
Pregnant women: 19
September 2009–December 2009
(4 months)
(i) Hospital mortality
(ii) Need for any duration of ventilation, tracheostomy, and skeletal muscle relaxants
(iii) Need for renal replacement therapy
(iv) Duration of ICU
(v) Hospital stay
Onset of infection:  
(i) Antepartum: 14 women
(ii) Postpartum: 5 women
Maternal mortality:
(i) 10 pregnant/postpartum women (52.6%) died
(ii) Other outcomes were not described separately for pregnant women
All patients received Oseltamivir; no separate mention of timing of initiation of Oseltamivir in pregnant women

4Gunasekaran (2012) [33]To determine the cumulative prevalence of H1N1 2009 influenza among pregnant and postpartum women in Tamil NaduChennai
(South India)
inpatient and outpatient
Overall population: 7638
Pregnant women: 126
September 2009–May 2011
(21 months)
Clinical and epidemiological characteristicsPrevalence of influenza virus:
(i) Influenza (pH1N1): 27 women (21.4%)
(ii) Influenza A/H3: 12 women (9.5%)
(iii) Influenza B: 2 women (1.6%)
Onset of infection:
(i) Antepartum: 12 women
(ii) Postpartum: 15 women
ICU admission and complication:
(i) Admitted in ICU and treated for severe outcomes: 3 (11.1%)
(ii) Admitted in obstetric ward and treated for moderate outcomes: 5 (18.5%) women
Maternal mortality:
(i) One woman died during postpartum period
Oseltamivir was initiated in patients considering their high-risk status

5Pramanick et al.
(2011) [34]
To assess the clinical profile of pregnant/puerperal women infected with pandemic H1N1 influenza A and to evaluate their outcomeVellore
(South India)
Hospital-basedOverall population: 566
Pregnant women: 20
August 2009–January 2010
(6 months)
Primary outcome
(i) Maternal mortality
Secondary outcomes
(ii) Need for ICU admission
(iii) Need for mechanical ventilation
(iv) Renal failure
(i) Out of 79 pregnant women, 20 (29%) women presenting with ILI/SARI were pregnant
Onset of infection:
(i) Antepartum: 16 women (80%)
(ii) Postpartum: 4 women (20%)
Length of pregnancy at presentation:
(i) Second trimester: 4 women (20%)
(ii) Third trimester: 11 women (55%)
(iii) 1 woman had molar pregnancy at 18 weeks of pregnancy
ICU admission:
(i) Required by 8 pregnant/postpartum (40%)
Maternal mortality: 5 women (25%) died
Fetal mortality: 1
(i) Renal failure: 4 women (20%)
(ii) Mechanical ventilation: 7 women (35%)
(iii) Seizures: 1 woman (5%)
Oseltamivir received by 18 women (90%); no mention of timing of initiation of Oseltamivir

6Puvanalingam et al. (2011) [35]To study clinical profile of H1N1 influenza cases and to study the impact of H1N1 infection on pregnancy outcomeChennai
(South India)
inpatient and outpatient
Overall population: 442
Pregnant women: 12
August 2009–January 2010
(6 months)
Clinical characteristics
and outcome of pregnant women
Length of pregnancy at presentation:
(i) First trimester: 2 (16.7%) women
(ii) Second trimester: none
(iii) Third trimester: 10 (83.3%) women
Maternal mortality:
3 women (25%) died
(i) 9 women (75%) presented with pneumonia
Fetal death:
(i) 2 women (16.7%) had spontaneous abortion following intrauterine death in the third trimester
Treatment: not mentioned

7Chudasama et al.
(2010) [32]
To investigated the clinicoepidemiological characteristics of patients who were hospitalized with 2009 pandemic H1N1 influenza virus infection and seasonal influenza in the Saurashtra region of IndiaRajkot
(West India)
Overall population: 773
Pregnant women: 15
September 2009–February 2010
(6 months)
Clinical and epidemiological characteristicsLength of pregnancy at presentation:
(i) All women presented in either 2nd or 3rd trimester
ICU admission:
(i) 11 women (73.3%) required intensive care
All patients received Oseltamivir, no separate mention of number of pregnant women that received the drug within 2 days of illness onset

8Sharma et al.
(2010) [39]
To describe the mortality data of severe influenza cases admitted in a tertiary care center in New DelhiNew Delhi
(North India)
Total: 8 women
Pregnant women: 2
September 2009 to January 2010
(5 months)
MortalityOut of 8 deaths due to influenza A (pH1N1), 2 women were pregnant
Length of pregnancy at presentation:
(i) First trimester: one woman
(ii) Postpartum period: one woman, child delivered by caesarean section