International Journal of Gynecology and Obstetrics (2006) 94, 131 — 132

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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
are mandatory for patients with DHF. As the
mortality rate of untreated in DHF may be as
high as 40%, early diagnosis and treatment are
important. Dengue fever should be suspected in
any pregnant woman with fever during epidemics
in endemic areas and followed with dengue
serology. If the mother acquired infection near
term or during labor, perinatal infection is to be
excluded with serologic studies and platelet
count even if the newborn is asymptomatic.
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