Dengue fever in pregnancy

Abstract

BACKGROUND: The true incidence of dengue infections during pregnancy is unknown and so far its effects and outcome are poorly documented. There are no guidelines on its management during pregnancy. OBJECTIVE: To describe the clinical and laboratory findings in a cohort of pregnant/puerperal women with dengue fever (DF)/dengue haemorrhagic fever (DHF) METHOD: Information was collected from all women with DF/ DHF notified from De Soysa Hospital for Women from 01.01.2000 to 04.06.2004. RESULTS: Of the 26 patients identified [mean (SD) age: 28.81ñ4.21 years], 9 (34.62 percent) had DF and 17 (65.38 percent) DHF. Fifteen (57.69 percent) and 7 (26.92 percent) lived in the Colombo and Gampaha districts respectively. 14 (53.85 percent) were reported between August and November each year. Three (11.54 percent) were 4 -12 days post-partum. 20 (86.96 percent) of the ante-natal subjects were in the third trimester, and 2 (8.7 percent) from the first and 1 (4.35 percent) from the second trimesters. Main clinical findings included: fever, chills, myalgia, arthralgia, headache, vomiting, abdominal pain, haemorrhagic manifestations and cough / breathlessness. Four (40 percent) of those who presented with cough/ breathlessness were managed initially as pulmonary embolism. Pleural effusions and hepatomegaly were present in 9 (34.62 percent) and 2 (7.69 percent) respectively 4 presenting with vaginal bleeding caused diagnostic problems. 7 (26.92 percent) required ICU management, 4 (15.38 percent) developed arrhythmia, and none developed shock. 20 (76.92 percent) had thrombocytopaenia, 19 (73.08 percent) had haemoconcentration and 13 (50 percent) had elevated liver enzymes. Dengue specific IgM and IgG antibodies were positive in 26 (100 percent) and 8 (30.77 percent) subjects. CONCLUSIONS: Awareness of the manifestations of DF/DHF in relation to pregnancy is necessary for early diagnosis and appropriate treatment.