Dengue Hemorrhagic Fever and its Effect on the Pregnancy Outcomes: A Case Series

Aninda Yasmin Farhanah, Amillia Siddiq, Tono Djuwantono, Putri Nadhira Adinda Adriansyah


Abstract


Background: Dengue fever in pregnancy is associated with a more severe presentation and an increased risk of adverse obstetric and neonatal outcomes. We describe three cases of dengue fever in pregnancy with different fetal outcomes (intrauterine fetal death, fetal distress, and healthy neonate).
Case Illustration: The first case involves a 23-year-old G1P0A0 at 31-32 weeks of gestation complaining of reduced fetal movement. She presented with a high-grade fever, anaemic, and thrombocytopenic. Her liver function was increased with AST 447 U/L and ALT 403 U/L. The fetal heart rate could not be detected.
The second case involves a 26-year-old G3P2A0 at term pregnancy complaining of labor pain. She presented with vaginal bleeding, high-grade fever, and vomiting five days prior. Her liver function was also increased (AST 301 U/L and ALT 298 U/L). At presentation, fetal distress was detected. The third case involves a 19-year-old G2P1A0 presented with high-grade fever and nausea for five days. Her liver function was moderately increased (AST 68 U/L and ALT 76 U/L). She delivered a 3050-gram healthy neonate vaginally.
Discussion: Dengue fever causes adverse obstetric outcomes. Endothelial injury exacerbated by plasma loss leads to placental dysfunction and poor fetal conditions. Unfortunately, dengue fever in pregnancy is not yet specifically addressed in our national guidelines.
Conclusion: Increased severity of dengue fever in pregnancy may cause poor maternal and fetal outcomes.

Demam Berdarah Dengue dan Dampaknya terhadap Luaran Kehamilan: Sebuah Serial Kasus

Abstrak
Pendahuluan: Demam berdarah dengue pada kehamilan terkait dengan tingkat keparahan penyakit dengue yang lebih berat dan meningkatnya risiko komplikasi obstetrik dan neonatus. Serial kasus ini menyajikan tiga kasus demam berdarah pada kehamilan dengan luaran janin yang berbeda (kematian janin intrauterine, gawat janin, dan neonatus sehat).
Presentasi Kasus: Kasus pertama, G1P0A0 gravida 31 – 32 minggu, berusia 23 tahun, datang dengan keluhan utama berkurangnya gerakan janin. Keluhan demam, nyeri retro-orbital, mual, dan muntah dirasakan sejak 4 hari sebelumnya. Terdapat tanda konjungtiva anemis, trombositopenia, dan fungsi liver meningkat (AST 447 U/L dan ALT 403 U/L). Detak jantung janin tidak terdeteksi. Kasus kedua, G3P2A0 gravida aterm, 26 tahun, datang dengan keluhan mules-mules, perdarahan jalan lahir, demam, mual, dan muntah dirasakan sejak 5 hari sebelumnya. Pasien mengalami trombositopenia dan peningkatan fungsi liver (AST 301 U/L dan ALT 298 U/L). Pemeriksaan janin menunjukkan tanda gawat janin. Kasus ketiga, G2P1A0 gravida aterm, 19 tahun, datang dengan keluhan utama mules-mules. Keluhan demam dan mual dirasakan sejak 5 hari. Pemeriksaan menunjukkan trombositopenia dan fungsi liver sedikit meningkat (AST 68 U/L dan ALT 76 U/L). Pasien melahirkan neonatus sehat secara spontan dengan berat 3050 gram.
Diskusi: Kebocoran plasma merupakan pencetus dari kerusakan endotel sehingga dapat mengakibatkan disfungsi plasenta dan kondisi janin memburuk. Namun, belum ada panduan resmi tatalaksana demam berdarah pada kehamilan di Indonesia.
Kesimpulan: Meningkatnya tingkat keparahan demam berdarah pada kehamilan menyebabkan luaran maternal dan neonatus yang buruk.

Kata kunci: Demam dengue, maternal, fetus, luaran, kehamilan


Keywords


Dengue fever; maternal; fetal; outcomes; pregnancy

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DOI: http://dx.doi.org/10.24198/obgynia.v7i2.678

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