A Case of Dengue Hemorrhagic Fever in Pregnant woman 34 weeks gestational age

*Cut Meurah Yeni, **Imam Zahari,

* Department of Obstetrics and Gynecology, Faculty of Medicine University of Syiah Kuala

** Fetomaternal division Syiah Kuala Hospital, Banda aceh - Indonesia

Abstract
Dengue hemorrhagic fever is a global problem of tropical disease, especially in Indonesia. In recent
times, the incidence has been increasing among adults and more cases of dengue fever and dengue
hemorrhagic fever in pregnancy are being reported. We managed one case of dengue hemorrhagic
fever during pregnancy which developed during antepartum periods. Patient complained contraction
and bloodslym since 8 hours before admission without waterbroke, patient went to midwife, and then
referred to RSCM, due to no facilities (no NICU). No history of cavities. Patient had history of
preterm labor in previous pregnancy. This case was treated conservatively. Two days after lung
maturation in the ward patient complained fever. We diagnosed dengue hemorrhagic fever during
pregnancy with clinical pictures of fever, hemoconcentration and thrombocytopenia with serological
proof, and positive in rumple leed test result. We decided to perform emergency C Section 5 days
after admission. Patient and the baby were in good condition before discharged. A sound knowledge
of its diagnosis and management plays a vital role for an obstetrician, particularly regarding the mode
of delivery. Supportive care with analgesics, bed rest, adequate fluid replacement and maintenance of
electrolyte balance forms the main stay of treatment.
Keywords: Dengue hemorrhagic fever, pregnancy
though coagulation defects are still ongoing.
Discussion However, when cesarean section is
We have presented cases of Dengue unavoidable, platelet concentrates should be
hemorrhagic fever seen during the antepartum given intraoperatively or post operatively as
periods. The clinical picture is as same as for necessary. The route of delivery should be
non pregnant patients. Antepartum given intraoperatively or post operatively as
management should be conservative. To our necessary. The route of delivery should be
knowledge, there is no report that the Dengue considered under obstetric indication.5
virus can cause congenital anomalies, Tocolytic drugs may be considered
spontaneous abortion, premature labour or until the patient recovers from the stage of
fetal death. The patients should be admitted to shock and the platelet count returns to a
a hospital for close observation. Intravenous normal level. Nevertheles, most of tocolysis
fluid replacement should be given if indicated. can cause tachycardia whic may obscure the
In this case, the patient was referred to RSCM patient status. Magnesium sulfate might be a
for preparation of NICU for preterm birth. drug of choice in this situation because of it
doesnt cause tachycardia.5
In this case, the platelet count was
reduced from 222,000 to 120,000 from the
It is uncertain whether the Dengue admission to the sixth day. So, we decided to
Virus can cause thrombocytopenia in neonate terminate the pregnancy by C section.
as seen in idiophatic thrombocytopenic The average incubation period of
purpura. Therefore, the treatments should be dengue fever is estimated to be about 7 days.
conservative, symptomatic and carried on Dengue infection in the neonate has been
through stage of shock. The critical periode reported in many studies. All babies were
(stage of shock) usually passed within 24 to 48 asymptomatic at birth except one who had
hours. If delivery is inevitable, the vaginal fever and was found to be dengue negative.
route is preferable to the abdominal route. Dengue serology was not performed on normal
Uterine contractions after delivery will babies and hence no comment could be made
strangulate the blood vessels that were torn on vertical transmission. However, studies
during parturition and cause hemostasis even conducted
in India, Thailand and Colombia failed to find
evidence of vertical transmission among their
study subjects.7

Reference
1. Narayana Swamy M1, Pooja Patil, T
Sruthi IOSR Journal of Dental and
Medical Sciences IOSR-JDMS e-ISSN:
2279-0853, p-ISSN: 2279-0861. Volume
13, Issue 2 Ver. I. Feb. 2014, PP 71-73
2. Pouliot SH, Xiong X, Harville E, Paz-
Soldan V, Tomashek KM. Maternal
dengue and pregnancy outcomes: a
systematicreview. ObstetGynecolSurv
2010;65: 107–118.
3. Adam I, Jumaa AM, Elbashir HM,
Karsany MS. Maternal and perinatal
outcomes of dengue in PortSudan,
Eastern Sudan. Virol J 2010;7: 153.
4. Deen JL, Harris E, Wills B, Balmaseda A,
Hammond SN, Rocha C et al. The WHO
dengue classification and case definitions:
time for a reassessment. Lancet 2011;368:
a. 170-3.
5. Suvit B, Somchai T, NimitT. Dengue
Hemorragic fever during pregnancy:
antepartum, intrapartum and postpartum
management j.Obstet. Gynacol. Res. Vol.
23, No.5:445-448 2012
6. Dengue fever. Yellow book traveller’s
Health. Atlanta: Centers for Disease
Control and Prevention; c2008.
7. Chye JK, Lim CT, Ng KB, Lim JM,
George R, Lam SK. Vertical transmission
of dengue. Clin Infect Dis 2007; 25: P.
1374–7.