International Journal of Gynecology and Obstetrics (2006) 94, 131 — 132
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BRIEF COMMUNICATION
Dengue infection in pregnancy
N. Malhotra, C. Chanana *, S. Kumar
Department of Gynecology and Obstetrics, All India Institute of Medical Sciences,
Sukhdev Vihar, New Delhi, India
Received 15 December 2005; received in revised form 17 April 2006; accepted 3 May 2006
diagnosed with hemolysis, elevated liver en-
KEYWORDS zymes, and low platelet count (HELLP) syndrome. Dengue infection; Pregnancy Serologic studies confirmed dengue infection in all but the woman misdiagnosed with HELLP. However, this patient tested positive for dengue infection after delivery. Those diagnosed with Dengue infection is endemic in tropical and sub- dengue fever during pregnancy responded to rest tropical countries, including India. When this viral and paracetamol treatment. Two of the women infection is not asymptomatic, it is diagnosed as had the signs and symptoms of DHF, with persis- dengue fever (DF), dengue hemorrhagic fever tent thrombocytopenia, rising hematocrit, and (DHF), and dengue shock syndrome. Dengue infec- fluid collection in the third space. Correction of tion is generally encountered in children younger fluid and electrolyte imbalance as well as multi- than 15 years, but pregnant women can also be ple platelet transfusions were helpful in the infected. The effect of dengue infection on preg- women with DHF. All patients recovered after nant women and their fetuses is unclear, although treatment. Although perinatal transmission of several cases and case series have been reported in dengue is well known [2—4], none of the neonates Refs. [1—3] (Table 1). born to these infected mothers had thrombocyto- During an epidemic of dengue in northern penia or any other sign of dengue infection. One India, 8 pregnant women were found to be of the neonates died of arthrogyposis congenita infected over a period of 6 months (June to during the first week. November 2005). Infection was present in all DHF requires special mention during pregnancy, trimesters of pregnancy. Diagnosis was straight- and must be differentiated from pre-eclampsia. forward, with fever and a classic rash in all of the There is an overlap of symptoms between the 2 women but one, patient 8, who was mistakenly conditions, such as thrombocytopenia, impaired liver function, capillary leak, edema, ascites, and decreased urinary output. A definite diagnosis can * Corresponding author. Tel.: +91 9810482629. only be confirmed serologically. Pregnant women E-mail address: charuchanana@rediffmail.com (C. Chanana). infected with dengue virus do not require a 0020-7292/$ - see front matter D 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2006.05.002 132 N. Malhotra et al.
Table 1 Description of 8 cases of dengue infection in pregnant women
Gravidity, No. of Symptoms Platelet Transaminase Diagnosis Treatment Maternal Newborn parity weeks with level level received4 outcome outcome infection G2, P1 8 Fever N N DF Per protocol VD, H 2.9 kg, H G1, P0 10 Fever, rash N N DF Per protocol CS, H 3.0 kg, H G1, P0 18 Fever, rash N N DF Per protocol VD, H 3.1 kg, H G3, P1 24 Fever N N DF Per protocol VD, H 3.1 k, H G1, P0 20 Fever, rash, Lowy N DHF Per protocol, VD, H 3.2 g, H ascites, pleural plus platelet effusion monitoring G2, P1 37 Fever, rash N N DF Per protocol VD, H 2.6 kg, died G4, P2 36 Fever N N DF Per protocol VD, H 3.0 kg, H G1, P0 36 Fever, rash, Lowz OT, N DHF Per protocol, CS, H 2.8 kg, H ascites, 345PT, 243 plus PRP increased BP, and FFP oliguria, albuminuria BP, blood pressure; CS, cesarean section; DF, dengue fever; DHF, dengue hemorrhagic fever; FFP, fresh—frozen plasma; G, gravida; H, healthy; N, normal; P, para; PRP, platelet-rich plasma; PT, prothrombin time; VD, vaginal delivery. 4 Per protocol indicates bed rest and treatment with paracetamol. y 60,000. z 10,000.
special treatment, and respond well to bed rest References
and an antipyretic agent such as paracetamol. Serial platelet counts and platelet transfusions [1] Carles G, Talarmin A, Peneau C, Bertsch M. Dengue fever and are mandatory for patients with DHF. As the pregnancy: a study of 38 cases in French Guiana. J Gynecol Obstet Biol Reprod 2000;29(8):758 – 62. mortality rate of untreated in DHF may be as [2] Janjindamai W, Pruekprasert P. Perinatal dengue infection: a high as 40%, early diagnosis and treatment are case report and review of literature. Southeast Asian J Trop important. Dengue fever should be suspected in Med Public Health 2003;34(4):793 – 6. any pregnant woman with fever during epidemics [3] Sirinavin S, Nuntnarumit P, Supapannachart S, Boonkaside- in endemic areas and followed with dengue cha S, Techasaensisi C, Yoksarn S. Vertical dengue infection: serology. If the mother acquired infection near case reports and review. Pediatr Infect Dis J 2004;23(11): 1042 – 7. term or during labor, perinatal infection is to be [4] Perret C, Chanthavanich P, Pengsaa K, et al. Dengue excluded with serologic studies and platelet infection during pregnancy and transplacental antibody count even if the newborn is asymptomatic. transfer in Thai mothers. J Infect Nov 2005;51(4):287 – 93.