What is the management of dengue (Dengue Fever) in pregnancy?

Management of Dengue in Pregnancy

Pregnant women with dengue require early diagnosis and aggressive management to prevent maternal and fetal complications, including hemorrhage, preterm birth, and death. 1, 2

Diagnostic Testing

• For symptomatic pregnant women, collect serum and urine specimens as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus nucleic acid amplification tests (NAATs) and IgM antibody testing 1
• Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests for all pregnant women 1
• Consider the epidemiology of viruses known to be circulating at the location of exposure and clinical findings when interpreting results 1

Clinical Assessment and Monitoring

• Monitor closely for warning signs including persistent vomiting, abdominal pain/tenderness, clinical fluid accumulation, mucosal bleeding, lethargy/restlessness, liver enlargement, and rising hematocrit with concurrent thrombocytopenia 3
• Assess for signs of shock, which occurs in approximately 40.9% of pregnant women with dengue 2
• Monitor for development of acute kidney injury (18.2%), acute respiratory distress syndrome (18.2%), and acute liver failure (9.1%), which are common complications in pregnant women with dengue 2
• Evaluate for thrombocytopenia, which occurs in approximately 52.3% of pregnant women with dengue 2

Management Principles

• Provide appropriate supportive care to monitor for and treat shock and hemorrhage without waiting for diagnostic test results 1
• Use acetaminophen/paracetamol for fever and pain management; strictly avoid NSAIDs and aspirin due to increased bleeding risk 3
• Ensure adequate hydration with fluids containing electrolytes; consider hospitalization for intravenous fluid therapy if persistent vomiting occurs 3
• Monitor closely for postpartum hemorrhage, which affects approximately 25% of women with dengue 2

Obstetric Considerations

• Increase surveillance for preterm delivery, which occurs in approximately 17-34% of pregnancies affected by dengue 2, 4
• Monitor for fetal distress and consider appropriate timing of delivery based on maternal condition and gestational age 4, 5
• Be prepared for potential obstetric complications including miscarriage, stillbirth, and intrauterine fetal death 2, 5
• Conservative obstetrical management is the treatment of choice when a woman acquires dengue while pregnant 6

Special Considerations

• Pregnancy does not appear to increase the incidence or severity of dengue, but dengue may predispose to certain pregnancy complications 6
• Transplacental infection can occur, though protective antibodies may also pass transplacentally 6
• Near-term maternal infection poses greater risk for severe fetal or neonatal illness 6
• Women in late pregnancy should avoid travel to dengue-endemic areas; those earlier in pregnancy should consider dengue a serious hazard 6

Multidisciplinary Approach

• Treat patients at centers with adequate resources for monitoring and emergency procedures 4
• Involve specialists in infectious diseases, maternal-fetal medicine, and critical care as needed based on disease severity 4, 5
• Ensure close follow-up after discharge to monitor for late complications 2, 5

Prognosis

• Maternal mortality rate is approximately 15.9% in severe cases 2
• Maternal near-miss cases (severe complications that nearly resulted in death) occur in approximately 15.9% of pregnant women with dengue 2
• Fetal/neonatal complications include miscarriage (4.5%), stillbirth (9%), and neonatal death (4.5%) 2
• Low birth weight occurs in approximately 29.5% of pregnancies affected by dengue 2