Dengue hemorrhagic fever in pregnancy complicated with placenta abruption and vertical transmission: A case report

Nadya Adi Kusuma , Anak Agung Ngurah Jaya Kusuma

Nadya Adi Kusuma
Department of Obstetric and Gynecology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali. Email:

Anak Agung Ngurah Jaya Kusuma
Department of Obstetric and Gynecology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali
Online First: August 04, 2017 | Cite this Article
Kusuma, N., Kusuma, A. 2017. Dengue hemorrhagic fever in pregnancy complicated with placenta abruption and vertical transmission: A case report. Bali Medical Journal 6(3): S100-S104. DOI:10.15562/bmj.v6i3.681

Background: Dengue Hemorrhagic Fever (DHF) is a main health problem in Indonesia, particularly in Bali. World Health Organization (WHO) reported Indonesia as the major contributor of DHF cases in the Southeast Asia and according to Indonesia national statistic report in 2010, Bali was the province with the highest incidence of DHF in Indonesia.

Case presentation: A 28 years old woman gravida 2 (para 0, abortus 1) at near term (35 weeks 2 days) gestational age, with threatened preterm delivery and premature rupture of membrane was admitted to Sanglah Hospital due to high probability of dengue infection (fever day 6) with warning signs (hemoconcentration) and thrombocytopenia (23,000/mm3). The dengue specific IgM and IgG antibodies were positive on the seventh day. On the progress, although the number of the platelet count tended to increase (WBC:9.99/mm3; Hb:14,3g/dL; Hct:44.6%; Plt:49,2x103/mm3), the patient developed antepartum haemorrhage due to placental abruption grade 2, and decided to have the Cesarean Section (CS) code green. No other maternal complications found, including bleeding from the surgical wound.

A preterm (35-36 weeks) baby was born with birthweight of 2500 gram and moderate asphyxia. On the second day, the baby’s serial blood counts showed a gradual rise in the haematocrit (>20% of baseline value) and a decline in platelet counts. DENV-4 dengue was detected in the infant’s blood (serum) on first day care using the polymerase chain reaction (PCR). The baby’s dengue NS1 antigen and the dengue specific IgG antibodies was positive on first day care while the dengue specific IgM was positive on the seventh day.

            Mother was discharged on the third day post operative, while the baby was discharged on the 10th day, in a good condition.

Conclusion: Symptomatic dengue infection during pregnancy increase the risk of preterm labor, bleeding, and low birthweight newborn. Secondary dengue infection are likely to have severe symptoms than the primary dengue infection. The vertical transmission of Dengue infection is rarely reported and the mechanism of transmission of the infection in the peripartum period remains unclear.


Chai, L.S.L., et al. Handbook for clinical management of dengue. WHO; 2012.

Machado C.R, et al. Is Pregnancy Associated with Severe Dengue? A Review of Data from the Rio Janeiro Surveillance Information System. PLOS Neglected Tropical Diseases, May 2013, Volume 7; Issue 5, e2217.

Sinhabahu VP, Sathananthan R, Malavige GN. Perinatal transmission of dengue: a case report. BMC Research Note, 2014; 7(795):1-3

CDC Laboratory Guidance and Diagnostic Testing, Available at, Accessed July 6, 2016.

Berghella, V., Visintine, J.F., Abruptio Placentae. Obstetric Evidence Based Guidelines: p.195-200. Informa Healthcare. 2007.

Wagner SM, Ural SH. An examination of The Causes, Diagnosis and Management Placental Abruption. Milton S. Hersey Medical Center; 2015

Vyas, R., Shah, S., Yadav, P., Patel, U. Comparative study of mild versus moderate to severe thrombocytopenia in third trimester of pregnancy in a tertiary care hospital. NHL Journal of Medical Sciences/ Jan 2014/ Vol 3/ Issue 1, p.8-11.

Guyton, A.C., Hall, J.E. Hemostasis and Blood Coagulation. Guyton and Hall Textbook of Medical Physiology Tweltfh Edition: p1026-1033. 2012.

Agrawal, P., et al. Pregnancy outcome in Women with Dengue Infection in Northern India. Indian Journal of Clinical Practice, April 2014, Vol. 24, No. 11.

Bunyavejchevin, S., et al. Dengue Hemorrhagic Fever during Pregnancy: Antepartum, Intrapartum, and Postpartum Management. J. Obstet. Gynaecol Res. Vol. 23, No. 5; 445-448, 1997.

Chalik, T.M.A. Perdarahan pada kehamilan lanjut dan persalinan. Ilmu Kebidanan Sarwono Prawirohardjo. Jakarta. Edisi IV. Penerbit PT.Bina Pustaka Sarwono Prawirohardjo; 2010.

Thaithumyanin, P., Thisyakorn, U., Deerojnawong, J., Innis, B.L., Dengue Infection Complicated by Severe Hemorrhage and Vertical Transmission in a Parturient Woman. Clinical Infectious Diseases 1994; 18:248-9. 1993.

Alverenga, C. F., et al. Dengue during Pregnancy: A Study of Thirteen Cases. American Journal of Infectious Diseases 5(4): 288-293, 2009.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JD, Hoffman BL, Casey BM, Sheffield JS. Williams Obstetrics. 24th ed. McGraw-Hill, 2014.

Ismail, N.A.M., et al. Seropositivity of Dengue Antibodies during Pregnancy. The Scientific World Journal Volume 2014, Article ID 436975.

Palmeira P, Quinello C, Lucia AS, Claudia AZ, Magda CS. IgG. Placental Transfer in Healthy and Pathological Pregnancies. Clinical and Developmental Immunology, 2012;1-14.

Argolo, A.F.L.T., et al. Prevalence and incidence of dengue virus and antibody placental transfer during late pregnancy in central Brazil. BMC Infectious Diseases 2013, 13: 254.

Ribeiro CF, Lopes VG, Brasil P, Coelho J, Muniz AG, Nogueira RM. Perinatal transmission of dengue: a report of 7 cases. J Pediatr, 2013;163(5):1514–1516.

No Supplimentary Material available for this article.
Article Views      : 28
PDF Downloads : 12