|Year : 2020 | Volume
| Issue : 3 | Page : 268
Dengue in pregnancy: An important problem in tropical obstetrics
Department of Community Medicine, Dr D.Y. Patil University, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Osun State, Nigeria
|Date of Submission||07-Oct-2019|
|Date of Decision||31-Dec-2019|
|Date of Acceptance||31-Dec-2019|
|Date of Web Publication||3-Jun-2020|
Department of Community Medicine, Dr D.Y. Patil University, Pune, Maharashtra; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Osun State
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wiwanitkit V. Dengue in pregnancy: An important problem in tropical obstetrics. Med J DY Patil Vidyapeeth 2020;13:268
Dengue is an important arbovirus infection that is the current public health problem in tropical countries. This infection is still an important vector borne disease that affects millions of world's population. In general, dengue is transmitted by Aedes mosquito vector. The infection can occur in any age groups. The infection in specific groups of patients such as pregnant women is interesting. The report of dengue in pregnancy published in Med J Dr DY Patil Univ is a good and interesting report showing the clinical epidemiology of dengue in pregnancy, which is a little-mentioned clinical problem in tropical obstetrics.
In general, a pregnant woman can get dengue infection by getting bitten by mosquito vector. The common clinical manifestation is acute febrile illness. In a recent report from Thailand, the most common clinical presentation of dengue infection in pregnant women is fever. In the case with second infection, the immunopathological process might lead to thrombocytopenia and bleeding presentation. The classical clinical triad of dengue, hemoconcentration, and atypical lymphocytosis and thrombocytosis might help in the presumptive clinical diagnosis of dengue. Nevertheless, in endemic settings, there are usually other infections that might clinically mimic dengue. In addition, the atypical laboratory finding such as low hematocrit and leukopenia is observable. The definitive diagnosis of dengue usually requires laboratory confirmation. Regarding dengue in pregnancy, the diagnosis is sometimes difficult. Sometimes, patients might have an uncommon chief complaint such as abdominal pain. In extremely rare case, there might be an uncommon intra-abdominal problem. A good example is acalculous cholecystitis.
For clinical management, symptomatic and supportive treatment is required. Standard fluid replacement therapy is recommended. For a pregnant patient, closed monitoring for hematological change is necessary.
The effect of infection on fetal in utero is also interesting. In a recent report from Thailand, it has been reported that pregnant dengue patients might present with threatened abortion. However, there is no clear conclusion on the association between dengue infection during pregnancy and abortion. In addition, there is no confirmation that dengue can increase the risk of preterm labor. There is also no evidence that dengue has teratogenic effect. Nevertheless, a recent meta-analysis showed that there is an association between dengue infection in pregnant women and preterm birth and low birthweight.
Finally, vertical transmission of dengue is possible. If dengue occurs during peripartum period, an important consideration is on vertical transmission. To diagnose vertical transmission is sometimes difficult and requires molecular diagnosis for confirmation. In an endemic area, there is also a chance that the newborn separated gets bitten by mosquito vector and acquires the disease.
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