11 February 2019
In an extremely rare case, doctors at Fortis Escorts Heart Institute (FEHI), Okhla, New Delhi, treated a 30 year old pregnant woman who had tested positive for swine flu (H1N1 virus). The case was extremely critical and complex as the foetus could not be delivered prematurely, but had to be protected from the virus while in the womb. Additionally, there was a risk of the mother developing bleeding complications and losing the unborn child. A team of doctors, led by Dr Vineeta Goyal, Senior Consultant, Critical Care Department took on this high risk case and treated the patient successfully through ECMO (Extracorporeal Membrane Oxygenation).
The patient was 24 weeks pregnant when she was presented to the hospital with fever, persistent cough and shortness of breath. Her symptoms had worsened over the course of a day and her blood oxygen levels were extremely low. Her breathing became progressively laboured and she had to be immediately put on ventilator support. However, her condition continued to deteriorate. When the predicted chances of survival for both the mother and child fell considerably, patient’s family was given the option for ECMO (Extracorporeal Membrane Oxygenation) machine which acts as a heart-lung bypass. It can support and perform the functions of the lung and the heart, individually and together.
Dr. Vineeta Goyal, Senior Consultant, Critical Care Department, Fortis Escorts Heart Institute said,“Complications, both maternal and foetal, were explained to the family. These included bleeding, intrauterine foetal death and spontaneous abortion. Within one hour of ventilation, ECMO was instituted. There was an immediate improvement in the blood oxygen levels of the patient. Since she had tested positive for the H1N1 virus, we had to treat her with antivirals such as ‘oseltamivir’. A Gynaecologist was consulted on regular basis and repeated ultrasounds were done to ensure foetal wellbeing. After fifteen days, patient was successfully weaned off ECMO and her foetus was alive and thriving. She was discharged on the 26th of January 2019 and both mother and baby remain healthy. Key to success is early referral to an ECMO centre. Critical Care Department of Fortis Escorts Heart Institute takes pride to have saved both mother and foetus when survival seemed impossible”.
Dr. Kousar Ali Shah, Zonal Director, Fortis Escorts Heart Institute said, “This case is the first reported case in India of a pregnant swine flu patient – where both the mother and the foetus survived. It was a challenging case, fraught with complications and risks. The possibility of survival was extremely low. However we took a chance and our efforts paid off. Putting the patient on ECMO was a sound and thought-out decision. Swine flu is an epidemic which is increasing at an alarming pace. If one feels even the slightest hint of infection they should get themselves tested immediately.”
The ECMO circuit acts as an artificial heart and lung for the patient during ECMO therapy. It can be used in patients of all ages. ECMO continues until the underlying cardiac or lung problem is improved or resolved. The typical course is around five days, but in some cases, ECMO support can be continued for up to 25 to 30 days.
Swine flu, commonly known as H1N1 virus, has three categories – A, B and C. While A and B categories need home care, category C requires immediate hospitalization and medical intervention as its symptoms and outcomes are extremely severe and could result in death. One should watch out for the primary influenza symptoms: high temperature, runny nose, cough, headache, muscle and joint pain. Precautionary measures should include the use of face masks and hand sanitizers. Additionally if the fever does not subside within 24 to 48 hours, medical counsel should be sought.