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

KEYWORDS
Dengue infection;
Pregnancy

Dengue infection is endemic in tropical and subtropical 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 infection is generally encountered in children younger
than 15 years, but pregnant women can also be
infected. The effect of dengue infection on pregnant women and their fetuses is unclear, although
several cases and case series have been reported in
Refs. [13] (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 straightforward, 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 enzymes, 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 persistent thrombocytopenia, rising hematocrit, and
fluid collection in the third space. Correction of
fluid and electrolyte imbalance as well as multiple platelet transfusions were helpful in the
women with DHF. All patients recovered after
treatment. Although perinatal transmission of
dengue is well known [24], none of the neonates
born to these infected mothers had thrombocytopenia 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

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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,
parity

No. of
weeks with
infection

Symptoms

Platelet
level

Transaminase
level

Diagnosis

Treatment
received4

Maternal
outcome

Newborn
outcome

G2,
G1,
G1,
G3,
G1,

P1
P0
P0
P1
P0

8
10
18
24
20

N
N
N
N
Lowy

N
N
N
N
N

DF
DF
DF
DF
DHF

2.9
3.0
3.1
3.1
3.2

37
36
36

N
N
Lowz OT,
345PT, 243

N
N
N

DF
DF
DHF

Per protocol
Per protocol
Per protocol
Per protocol
Per protocol,
plus platelet
monitoring
Per protocol
Per protocol
Per protocol,
plus PRP
and FFP

VD, H
CS, H
VD, H
VD, H
VD, H

G2, P1
G4, P2
G1, P0

Fever
Fever, rash
Fever, rash
Fever
Fever, rash,
ascites, pleural
effusion
Fever, rash
Fever
Fever, rash,
ascites,
increased BP,
oliguria,
albuminuria

VD, H
VD, H
CS, H

2.6 kg, died

3.0 kg, H
2.8 kg, H

kg, H
kg, H
kg, H
k, H
g, H

BP, blood pressure; CS, cesarean section; DF, dengue fever; DHF, dengue hemorrhagic fever; FFP, freshfrozen 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
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