# Multidisciplinary Management of Severe Maternal H1N1 Infection With Acute Respiratory Distress Syndrome and Ventilator-Associated Pneumonia Requiring Extracorporeal Membrane Oxygenation: A Case Report

## TL;DR

A pregnant woman with severe H1N1 infection required emergency cesarean section and ECMO, showcasing successful management of life-threatening complications during pregnancy.

## Contribution

Demonstrates successful maternal survival and neonatal outcome through ECMO and targeted treatment of multidrug-resistant pneumonia during pregnancy.

## Key findings

- Emergency cesarean section delivered a viable preterm infant despite severe maternal H1N1 infection.
- Extracorporeal membrane oxygenation (ECMO) and targeted antibiotics successfully managed ARDS and multidrug-resistant VAP.
- Multidisciplinary coordination led to stable maternal and neonatal outcomes after 40 days of intensive care.

## Abstract

Pregnant women are at increased risk of severe H1N1 infection, which can lead to complications such as acute respiratory distress syndrome (ARDS) and secondary infections. We report a 29-year-old woman at 29 weeks of gestation who developed fever, cough, and rapidly worsening respiratory distress. Initial management included oxygen therapy, Bilevel Positive Airway Pressure (BiPAP), antivirals, antibiotics, and antenatal corticosteroids; however, worsening hypoxemia necessitated an emergency cesarean section, resulting in the delivery of a viable preterm infant. Postoperatively, she required mechanical ventilation, prone ventilation, and venovenous extracorporeal membrane oxygenation (ECMO). Ventilator-associated pneumonia (VAP) due to multidrug-resistant organisms was successfully treated with targeted antibiotics. The patient was gradually weaned from ECMO and ventilatory support and discharged in stable condition with her newborn after 40 days. This case highlights the importance of timely obstetric intervention, advanced respiratory support, and multidisciplinary coordination in achieving favorable maternal and neonatal outcomes, and demonstrates successful maternal survival with ECMO and treatment of multidrug-resistant VAP during pregnancy.