European Journal of Cardiovascular Medicine

Prevalent in the South Asian and South-east Asian regions of the world.¹ In terms of dengue, India too has a substantial socioeconomic and illness burden. Dengue fever is defined by the World Health Organization as an acute febrile illness with two or more of the following signs and symptoms: severe headache, pain at the back of the orbit, myalgia, arthralgia, rash, leukopenia, and hemorrhagic symptoms.

Clinically, dengue can range in severity from a low-grade, self-limiting fever to thrombocytopenia and increased permeability of blood vessels. Pleural effusion, ascites, hypoproteinemia, and an increased haematocrit greater than 20% of the age-specific norm are all indications of plasma leakage.² There are several physiological changes in the body that are linked to pregnancy. Furthermore, a dengue infection during this time raises the chance of fetal problems like low birthweight, preterm, and intrauterine fetal death in addition to posing a risk to the mother.³ Dengue during pregnancy raises the mother's and the unborn child's risk of hemorrhaging. It has been observed that vertical transmission to the neonate.⁴ While research on dengue's impact on pregnancy is scarce, it is known to cause issues such preterm births, low birth weights, pre-eclampsia, and an increased risk of cesarean sections.⁵

The Government of India's National Guidelines for Dengue Management classify pregnancy as the highest-risk category for severe dengue fever and dengue hemorrhagic syndrome symptoms and consequences.⁶ As a result, they need to be closely watched for the development of problems and serious infection. According to national statistics, there appears to be a yearly spike in dengue cases between July and November, particularly in the southern and western regions of India, specifically in Andhra Pradesh, Chandigarh, Delhi, Goa, Haryana, Gujarat, Karnataka, Kerala, Maharashtra, Puducherry, Tamil Nadu, and West Bengal.⁷ The purpose of this study was assess the maternal and fetal outcomes of dengue in pregnancy.

Type of study : Present study was institutional based prospective observational study.

Place of study : Department of Gynaecology and Obstetrics, College of Medicine & Sagar Dutta Hospital, Kamarhati, Kolkata, West Bengal,

Time of study : The study started with the submission of research proposal. After receiving the clearance from the ethical committee study was conducted from June 2022 to December 2022.

Study Population : All pregnant patients attending out-patient department of Gynaecology and Obstetrics, College of Medicine & Sagar Dutta Hospital, Kamarhati, Kolkata with fever and serologically confirmed dengue infection were included in the study.

Inclusion criteria : Patients of 20-40-year age with viable pregnancy confirmed with ultrasound, having fever which is clinically recordable, dengue serology, NS1 antigen and/or IgG or IgM positive, by ELISA method and patients willing to follow-up after delivery upto 6 weeks.

Exclusion criteria : Patients with non-viable pregnancy and fever with negative dengue serology and those who refused consent. 

As the present study was institutional based prospective observational study, data of 40 pregnant patients with confirmed dengue infection were collected. This included their age, parity, gestational age, detailed history, clinical examination, relevant blood investigations (complete blood counts, serial platelet counts, liver function test, renal function test, coagulation profile). Few patients with dengue haemorrhagic fever had severe complications and were managed in intensive care units. These patients were evaluated further depending on case to case basis.

Data Analysis plan- The data were entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. P-value ≤ 0.05 was considered for statistically significant

Ethical considerations- Study was initiated after obtaining the informed consents from the participants and ethical clearance from the institutional ethical committee.

In our study platelet count of 4 (10%) patients were > 2 lac followed by platelet count 1.5 to 2 lac 8 (20%) and 1 to 1.5 lac 6 (15%). Platelet count of 9 (22%) patients were <25000 lac and platelet count of 13 (33%) patients were 15000 to 50000 lac. (Figure 1)

In the present study 3 (7.50%) patients need ICU care followed by 9 (22.50%) need platelet transfusion, 7 (17.50%) need C PAP, 8 (20%) need PPH, 7 (17.50%) need abortion and 2 (5%) patients need abruption. (Table 1)

In the present study 16 (40%) patients have term vaginal delivery followed by 8 (20%) were term caesarean delivery, 4 (10%) were preterm vaginal delivery, 8 (20%) need abortion, 2 (5%) each need abruption and IUFD. (Table 2)

In the present study 5 (12.5%) fetals suffered from fetal distress followed by 2 (5%) suffered from Oligohydramnios, 6 (15%) meconium stain liquor complications and there was 4 (10%) fetal death. (Table 3)

In the present study 4 (35%) neonatal were normal. 8 (20%) neonatal need SNCU admission, 2 (5%) neonatal need NICU admission. There was 4 (10%) neonatal death. (Table 4)

Any pregnant patient complaining of fever should be checked for dengue during dengue outbreaks. In order to detect infection early, initiate supportive therapy, and assess for consequences, the clinician should maintain a high index of suspicion. Since any infection during pregnancy is a major cause of concern, in-patient care should be offered for feto-maternal surveillance as well as to help the nervous patient and her relatives feel less stressed.⁷

In this study platelet count of 4 (10%) patients were > 2 lac followed by platelet count 1.5 to 2 lac 8 (20%) and 1 to 1.5 lac 6 (15%). Platelet count of 9 (22%) patients were <25000 lac and platelet count of 13 (33%) patients were 15000 to 50000 lac.

The American College of Obstetrics and Gynecology (ACOG) advises against major surgery until the mother's platelet count is greater than 50,000/µL. In the meantime, spinal and epidural anesthesia are deemed safe as long as the platelet count is greater than 70,000/µL in order to reduce the risk of epidural hematoma.⁸

In our study 3 (7.50%) patients need ICU care followed by 9 (22.50%) need platelet transfusion, 7 (17.50%) need C PAP, 8 (20%) need PPH, 7 (17.50%) need abortion and 2 (5%) patients need abruption. In the study conducted by Singh T et al. overall, 4 patients required ICU care, two needed ventilatory support and platelet transfusion was given to two patients out of the 13 cases that were managed.⁹

Present study reveals that 16 (40%) patients have term vaginal delivery followed by 8 (20%) were term caesarean delivery, 4 (10%) were preterm vaginal delivery, 8 (20%) need abortion, 2 (5%) each need abruption and IUFD.

In the study conducted by Rinnie Brar et al out of 40 women who delivered, 26 (65%) delivered

vaginally and 14 (35%) delivered by caesarean delivery.¹⁰

In our study 5 (12.5%) fetals suffered from fetal distress followed by 2 (5%) suffered from Oligohydramnios, 6 (15%) meconium stain liquor complications and there was 4 (10%) fetal death.

In the present study 4 (35%) neonatal were normal. 8 (20%) neonatal need SNCU admission, 2 (5%) neonatal need NICU admission. There was 4 (10%) neonatal death.

Several previous studies have shown that dengue in pregnancy can increase the risk of postpartum hemorrhage (PPH), premature labor, severe oligohydramnios, neonatal and fetal death, and vertical transmission requiring platelet transfusion for neonatal thrombocytopenia.^8,10,11

The clinical course of dengue in pregnant individuals and its impact on the normal course of pregnancy are the main topics of this study. To control the infection and guarantee the best possible results for both the mother and the fetus, a high degree of clinical suspicion, a low threshold for in-patient care, intensive supportive therapy, close materno-fetal monitoring, and prompt obstetric care are necessary.

1. Gehlot H, Yadav OP, Sharma S, Nagar GG, Yadav A, Gupta PP. A study of dengue fever in pregnancy and its maternal and fetal prognosis. Int J Reprod Contracept Obstet Gynecol. 2017;6:3414r7.
2. Kanakalatha D, Radha S, Nambisan B. Maternal and fetal outcome of dengue fever during pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016;5(11):3959-64.
3. Pavanaganga A, Sailakshmi MP, Rekha BR, Nagarathnamma R. Dengue fever during pregnancy: maternal and fetal complications. J South Asian Fed Obstet Gynaecol. 2017;9(2):88-91.
4. Singh N, Sharma KA, Dadhwal V, Mittal S, Selvi AS. A successful management of dengue fever in pregnancy: report of two cases. Indian J Med Microbiol. 2008;26(4):377.
5. Machain-Williams C, Raga E, Baak-Baak CM, Kiem S, Blitvich BJ, Ramos C. Maternal, fetal, and neonatal outcomes in pregnant dengue patients in Mexico. BioMed Res Int. 2018;2018.
6. National Guidelines for Clinical Management of Dengue Fever- NVBDCP. Director General of Health Services, Ministry of Health and Family Welfare, Government of India; World Health Organisation, 2015. Available at: pbhealth.gov.in. Accessed on 05th February 2020.
7. Dengue in Pregnancy: Management protocols FOGSI; 2014. Available at: https://www.fogorg/ wp-content/uploads/2015/11/dpmp.pdf. Accessed on 05th February 2020.
8. Hung LP, Nghi TD, Anh NH, et al. Case report: postpartum hemorrhage associated with dengue with warning signs in a term pregnancy and delivery. F1000Res 2015;4:1483.
9. Singh T, Singh SM, Paprikar MM. Dengue in pregnancy, maternal and fetal outcome: a case series managed at a Zonal Hospital. Int J Reprod Contracept Obstet Gynecol 2020;9:2420-3.
10. Rinnie Brar, Pooja Sikka, Vikas Suri et al. Maternal and fetal outcomes of dengue fever in pregnancy: a large prospective and descriptive observational study. Archives of Gynecology and Obstetrics (2021) 304:91–100.
11. Kariyawasam S, Senanayake H. Dengue infections during pregnancy: case series from a tertiary care hospital in Sri Lanka. J Infect Dev Ctries 2010;4(11):767–775