Dengue hemorrhagic fever in pregnancy with placenta abruption and vertical transmission a case report

Background: Dengue Hemorrhagic Fever (DHF) is endemic in Indonesia, particularly in Bali. World Health Organization (WHO) reported Indonesia as the major contributor of DHF cases in the Southeast Asia. Moreover, Indonesia national statistical report in 2010 showed that Bali was the province with the highest incidence of DHF in Indonesia. The infection may occur in a pregnant woman. Case presentation: A 28 years old female was admitted to our hospital with gravida 2 (para 0, abortus 1) at 35 weeks and 2 days of gestational age, with threatened preterm delivery and premature rupture of the membrane. She was suspected of dengue infection accompanied by hemoconcentration and thrombocytopenia. On the following day, the dengue specific IgM and IgG were positive. Although the number of the platelet count increased, the patient developed antepartum hemorrhage due to placental abruption grade 2. Thus, she went through a Cesarean Section (C-section) code green. The preterm baby was 2500 gram, suffered from moderate asphyxia. On the first day of care, the baby’s dengue NS1 antigen and the dengue-specific IgG antibodies were positive. Moreover, DENV-4 dengue was detected in the infant’s serum. On the second day, the baby’s serial blood counts showed a gradual rise in the hematocrit (>20% of baseline value) and a decline in platelet count. The dengue specific IgM was positive on the seventh day. The mother was discharged on the 3rd day post-C-section, while the baby was discharged on the 10th day. Conclusion: Symptomatic dengue infection during pregnancy increases the risk of preterm labor, bleeding, and low birthweight newborn.