Dengue fever is endemic in the South East Asia. Dengue in pregnancy is particularly to treat due to the physiological changes during pregnancy. This slide presentation discusses about DF in pregnancy.

1. TKT

2. 2
CPG Management of Dengue Infection
in Adults (3rd Edition)
 Physiological changes in pregnancy
 Challenge in diagnosis of dengue in
pregnancy
 Pregnancy outcome, maternal and fetal
complications of dengue infection in
pregnancy
 Management and recommendations

3. ANTENATAL MANAGEMENT
• Dengue infection carries higher risk of
maternal and fetal mortality in 1st and 3rd
trimesters
• High index of suspicion in handling severe
DF in pregnancy is crucial as signs/sx of
severe DF can be MASKED by
physiological changes in pregnancy.

4. 4
CPG Management of Dengue Infection
in Adults (3rd Edition)
Erythropoesis
 Hb/HCT/Plt ↓
 WCC ↑
Heart
 HR ↑
 BP ↓
Lungs
 RR ↑
 pO2 ↑ (101–105 )
 pCO2 ↓ (28-31 )
 HCO3 ↓ (18-21 )
Liver
 Alb ↓ ;ALP ↑

5. Adapted from: Burwell CS and Metcalfe JA: Heart disease and Pregnancy: Physiology and
Management. Boston: Little, Brown and Co.; 1958.
CHANGES IN HR DURING PREGNANCY

6. Adapted from: Burwell CS and Metcalfe JA: Heart disease and Pregnancy: Physiology and
Management. Boston: Little, Brown and Co.; 1958.
CHANGES IN BP DURING PREGNANCY

7. • Authors searched Medline, Embase, Global
Health Library, and Scopus for articles
published before Aug 1, 2015.
• 16 studies - eligible for systematic review and 8
for the meta-analyses
Paixao, Enny & Teixeira, Maria & Costa, Maria & Rodrigues, Laura. (2016). Dengue during pregnancy
and adverse fetal outcomes: A systematic review and meta-analysis. The Lancet. Infectious diseases.
16. 10.1016/S1473-3099(16)00088-8.

8. DF and Miscarriage
Paixao, Enny & Teixeira, Maria & Costa, Maria & Rodrigues, Laura. (2016). Dengue during pregnancy
and adverse fetal outcomes: A systematic review and meta-analysis. The Lancet. Infectious diseases.
16. 10.1016/S1473-3099(16)00088-8.

9. DF and Preterm Birth
Paixao, Enny & Teixeira, Maria & Costa, Maria & Rodrigues, Laura. (2016). Dengue during pregnancy
and adverse fetal outcomes: A systematic review and meta-analysis. The Lancet. Infectious diseases.
16. 10.1016/S1473-3099(16)00088-8.

10. DF and Low Birth Weight/IUGR
Paixao, Enny & Teixeira, Maria & Costa, Maria & Rodrigues, Laura. (2016). Dengue during pregnancy
and adverse fetal outcomes: A systematic review and meta-analysis. The Lancet. Infectious diseases.
16. 10.1016/S1473-3099(16)00088-8.

11.  Severe infection
PPH
Pre-eclampsia
Eclampsia
Dengue
encephalopathy
Preterm delivery
Still-birth
Miscarriage
Low Birth Weight
Vertical
transmission

12. 12
CPG Management of Dengue Infection
in Adults (3rd Edition)
 All pregnant mothers
with dengue should
be co-managed in
hospitals by
physician,
anaesthetist,
obstetrician,
paediatrician
• SVD is allowed
• Close fetal
monitoring is
required to detect
fetal distress
• Advisable to delay
the delivery until
acute infection
resolve.
•Chitra TV, Panicker S. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis. 2011;48(4):210–3.
•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):767–75.

13. 13
CPG Management of Dengue Infection
in Adults (3rd Edition)
 Instrumental deliveries
are best avoided
 Blood products should
be available prior to
LSCS/instrumental
delivery
 IM injection- NO!!
• IV uterotonic agent is
recommended at 3rd
stage of labor
• Platelet transfusion is
required when:
 Bleeding
 LSCS/instrumental
deliveries
 If platelet count < 50K/mL
•Chitra TV, Panicker S. Maternal and fetal outcome of dengue fever in pregnancy. J Vector Borne Dis. 2011;48(4):210–3.

14. • Transmission of dengue virus through
breastfeeding is INCONCLUSIVE.
• Adviseable->to delay breastfeeding during
the acute viraemic phase. *
• It is NOT CONTRAINDICATED. **
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* (Barthel et al, 2013. Breast milk as a possible route of vertical
transmission of Dengue virus?)
** SWACH Labor Room Protocol

15. What’s about baby?
Congenital DF infection (vertical transmission)
needs to be ruled out.

16.  Physiological changes in pregnancy
 Challenge in diagnosis of dengue in
pregnancy
 Pregnancy outcome, maternal and fetal
complications of dengue infection in
pregnancy
 Management and recommendations
CPG Management of Dengue Infection in Adults
(3rd Edition)

17. REFERENCE
• Malaysian CPG Management of Dengue
infection in adults (3rd edition)
• SWACH Labor Room Protocol (Revised
July 2018)

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