Publication:

A study of dengue fever in pregnancy and its maternal and fetal prognosis

Background Dengue is a vector borne viral disease. Female Anopheles mosquito is the vector for the disease. Recently, there is an increase in the incidence of dengue fever in adult population in South Asian countries. With increasing rate of adult dengue fever victims, the number of infected pregnant women has also been increased. Dengue, during pregnancy may be associated with various complications, including abortions, preterm delivery, maternal mortality, low birth weight, neonatal admissions and fetal anomalies. Timely intervention can improve the maternal as well as fetal outcome. This study was aimed to assess the clinical profile, maternal and fetal outcome of dengue fever during pregnancy.

Methods The study was carried out on 25 pregnant females diagnosed and serologically confirmed to have dengue fever and were admitted in Umaid hospital, associated to Dr. S. N. Medical College Jodhpur, Rajasthan, India. Patients were included irrespective of the period of gestation of contracting the disease. Serological testing for dengue virus specific antigen and antibody was done for the diagnosis of dengue fever. The World Health Organization (WHO) classification and case definitions 2009 were used to categorize the dengue patients. A predesigned proforma was used to collect data related to maternal and fetal consequences both during pregnancy and at birth, as well as the effect on the newborn. Informed and written consent was taken from all those who participated in the study.

Results Thrombocytopenia (platelet count <1.5lakh/mm3) was found in 22 (88%) patients out of which 6 (24%) of them had platelet count below 20,000 cells/mm3 and 3(12%) patients required platelet transfusion. Other complications observed were spontaneous abortions (4%); preterm birth (16%), oligohydramnios (8%) and antepartum hemorrhage (4%). One patient was admitted to Intensive Care Unit. Fetal distress and meconium stained amniotic fluid was observed in 16% and 12% patients respectively. Adverse fetal outcome was observed in form of low birth weight, prematurity. 8% of the babies required NICU admission and 4% were Intra Uterine Fetal Death (IUFD).

Conclusions Maternal infection with the dengue virus during antenatal period represents a real risk of premature birth. Early onset or late onset in pregnancy appeared to have a bad prognosis.  A high index of clinical suspicion is essential in any pregnant woman with fever during the epidemic. The treatment of dengue in pregnancy is mainly conservative as in non-pregnant adults. In case of high risk cases early referral to well-equipped health centres where technical, transfusion and intensive care facilities are available may prove lifesaving.