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

of Gynecology and Obstetrics (2006) 94 , 131 — 132 www.elsevier.com/locate/ijgo BRIEF COMMUNICATION Dengue
of Gynecology and Obstetrics (2006) 94 , 131 — 132 www.elsevier.com/locate/ijgo BRIEF COMMUNICATION Dengue

www.elsevier.com/locate/ijgo

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

KEYWORDS

Dengue infection;

Pregnancy

Dengue infection is endemic in tropical and sub- tropical countries, including India. When this viral infection is not asymptomatic, it is diagnosed as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome. Dengue infec- tion is generally encountered in children younger than 15 years, but pregnant women can also be infected. The effect of dengue infection on preg- nant women and their fetuses is unclear, although several cases and case series have been reported in Refs. [1—3] ( Table 1 ). During an epidemic of dengue in northern India, 8 pregnant women were found to be infected over a period of 6 months (June to November 2005). Infection was present in all trimesters of pregnancy. Diagnosis was straight- forward, with fever and a classic rash in all of the women but one, patient 8, who was mistakenly

* Corresponding author. Tel.: +91 9810482629. E-mail address: charuchanana@rediffmail.com (C. Chanana).

diagnosed with hemolysis, elevated liver en- zymes, and low platelet count (HELLP) syndrome. 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 fever during pregnancy responded to rest and paracetamol treatment. Two of the women had the signs and symptoms of DHF, with persis- tent thrombocytopenia, rising hematocrit, and fluid collection in the third space. Correction of fluid and electrolyte imbalance as well as multi- ple platelet transfusions were helpful in the women with DHF. All patients recovered after treatment. Although perinatal transmission of dengue is well known [2—4] , none of the neonates born to these infected mothers had thrombocyto- penia or any other sign of dengue infection. One of the neonates died of arthrogyposis congenita during the first week. DHF requires special mention during pregnancy, and must be differentiated from pre-eclampsia. There is an overlap of symptoms between the 2 conditions, such as thrombocytopenia, impaired liver function, capillary leak, edema, ascites, and decreased urinary output. A definite diagnosis can only be confirmed serologically. Pregnant women 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.

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 received 4

Maternal

Newborn

parity

weeks with

level

level

outcome

outcome

infection

G2, P1

8

Fever

N

N

DF

Per protocol

VD, H

2.9 kg, H 3.0 kg, H 3.1 kg, H 3.1 k, H 3.2 g, H

G1, P0

10

Fever, rash

N

N

DF

Per protocol

CS, H

G1, P0

18

Fever, rash

N

N

DF

Per protocol

VD, H

G3, P1

24

Fever

N

N

DF

Per protocol

VD, H

G1, P0

20

Fever, rash,

Low y

N

DHF

Per protocol,

VD, H

 

ascites, pleural

plus platelet

effusion

monitoring

G2, P1

37

Fever, rash

N N Low z OT, 345PT, 243

N

DF

Per protocol

VD, H

2.6 kg, died 3.0 kg, H 2.8 kg, H

G4, P2

36

Fever

N

DF

Per protocol

VD, H

G1, P0

36

Fever, rash,

N

DHF

Per protocol,

CS, H

 

ascites,

 

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 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.

References

[1] Carles G, Talarmin A, Peneau C, Bertsch M. Dengue fever and pregnancy: a study of 38 cases in French Guiana. J Gynecol Obstet Biol Reprod 2000;29(8):758 – 62. [2] Janjindamai W, Pruekprasert P. Perinatal dengue infection: a case report and review of literature. Southeast Asian J Trop Med Public Health 2003;34(4):793 – 6. [3] Sirinavin S, Nuntnarumit P, Supapannachart S, Boonkaside- cha S, Techasaensisi C, Yoksarn S. Vertical dengue infection:

case reports and review. Pediatr Infect Dis J 2004;23(11):

1042 – 7. [4] Perret C, Chanthavanich P, Pengsaa K, et al. Dengue infection during pregnancy and transplacental antibody transfer in Thai mothers. J Infect Nov 2005;51(4):287 – 93.