A Trimester-by-Trimester Guide to Swine Flu and Pregnancy

NSW Health has released some guidelines around the treatment of pregnant women with suspected Swine Flu. Expectant mothers may want to heed to various advice and concerns for each trimester of pregnancy. Here is an excerpt.

First trimester

• - In the first trimester, the concern is largely about the effect the mother’s fever may have on the developing fetus, including miscarriage
• - Symptomatic treatment with paracetamol is recommended to reduce fever
• - Treatment with anti-influenza medicine should be discussed with the mother, taking into account other conditions that may increase her risk of severe disease.

Second and third trimester

• - In the second and third trimesters, the concern is largely for severity of illness in the mother, a well as the potential effects of the mother’s fever on the developing fetus
• - Symptomatic treatment with paracetamol is recommended to reduce fever
• - Assessment of maternal and fetal wellbeing is recommended at every presentation
• - Treatment with anti-influenza medicine is strongly recommended to reduce the severity of disease in the mother.

Around the time of birth

• - Around the time of birth, the concern is about both the severity of illness in the mother and the risk of transmission to the baby
• - Symptomatic treatment with paracetamol is recommended to reduce fever
• - Treatment with anti-influenza medicine of the mother is strongly recommended to reduce the severity of disease
• - While the baby is <3 months old, treatment of the mother is also recommended to reduce the risk of transmission to the baby
• - The mother should not be asked to wear a mask during labour and birth, but others in the room should follow infection control guidelines
• -There is usually no advantage in expediting the birth of the baby.

Minimising the risk of infection from mother to baby

• - The spectrum of disease of H1N1 influenza 09 in newborns is unclear
• - Breast feeding should be strongly encouraged
• - Sensible efforts should be made to reduce the likelihood the baby will be infected, while minimising the effect on the mother-baby relationship. These include:

• - treating the mother to reduce the risk of transmission (the mother is considered noninfectious after 72 hours of treatment with anti-influenza medicine)
• - the mother and baby should sleep at least 1 metre apart, in the same room (at least while in hospital), in separate beds
• - when breast feeding, bathing, caring for, cuddling, or otherwise being within 1 metre of the baby, the mother should:

- wear a surgical mask
- wash her hands thoroughly with soap and water before interacting with the baby
- the mother should avoid coughing and practice cough etiquette near the baby
- although these measures can be ceased when the mother is no longer infectious, continued good hygiene should be encouraged at all times
- these measures should apply to any carer or family member with influenza
- Mothers requiring hospital care should not be prematurely discharged because they have influenza
- If discharged while still infectious, mothers should be provided with a sufficient supply of surgical masks to take home.

Hopefully that answers a few questions. NSW Health reiterate RANZCOG’s advice that pregnant women avoid large crowds but that there is no need for well people to wear surgical masks, or to exclude themselves from regular activities.