Pregnancy with Dengue Haemorrhagic Fever in Zainoel Abidin

General Hospital Banda Aceh: a Case Report

Mohd Andalas*, Febrina Yolanda** , Ashabul Anhar**, Romi sattria**

Abstrak

Demam berdarah dengue adalah penyakit menular berbahaya yang disebabkan oleh
virus, menyebabkan gangguan pada pembuluh darah kapiler dan sistem pembekuan darah
sehingga mengakibatkan perdarahan. Virus dengue tergolong arbovirus, termasuk famili
Togaviridae yang merupakan penyebab pada demam dengue. Prevalensi nasional Demam
Berdarah Dengue adalah 0,62%. Demam berdarah dengue dalam kehamilan dapat
menyebabkan prematuritas, kematian janin dalam rahim dan gangguan keseimbangan
elektrolit pada ibu. Berikut akan dibahas mengenai kasus seorang wanita 30 tahun dengan
usia kehamilan 20 minggu datang dengan keluhan demam hilang timbul sejak 4 hari yang
lalu dan disertai mual muntah. Pada kasus ini akan di bahas mengenai demam berdarah
dengue dalam kehamilan.

Kata kunci : demam berdarah dengue, dengue, demam berdarah dengue dalam kehamilan.

Abstract
Dengue Haemorrhagic Fever is severe infection disease caused by a virus affect
capillary and coagulation system, resulting bleeding and death. Dengue virus classified as
arbovirus in Togaviridae family which cause dengue fever. The national prevalence of
dengue haemorrhagic fever is 0.62%. Dengue haemorrhagic fever in pregnancy could lead
prematurity, intrauterin fetal death, and electrolytes imbalance for mother. We will discuss
about pregnant woman in 20 weeks gestational age who had fever for 4 days, nausea and
vomitus. In this case, we will discuss about dengue haemmorhagic fever in pregnancy.

Keyword: dengue haemorrhagic fever, dengue, dengue haemorrhagic fever in pregnancy

*Lecturer in Obstetrics and Gynecology Department of Medical School Syiah Kuala

University/Zainoel Abidin General Hospital Banda Aceh
** Clinical clerkship in Obstetrics and Gynecology Department of Medical School Syiah
Kuala University

febyolandaa@gmail.com
Introduction Dengue virus infection can occur at
different ages and circumstances, not least
Dengue fever is a systemic
in pregnancy.4 There is no many reports of
infectious disease caused by dengue virus.
dengue fever occur in pregnancy in
Dengue Haemorrhagic Fever is severe
Indonesia, but several case reports from
infection disease caused by a virus affect
various countries have been published.
capillary and coagulation system, resulting
Treatment of dengue hemorrhagic fever in
1
bleeding and death. Outbreaks of dengue
pregnancy has a special aspect because
fever in Europe occurred in 1784, while in
various physiological changes that occur in
South America between 1871-1873. The
pregnancy resulting special modifications
term of haemorrhagic fever in Southeast
in fluid therapy, therefore this case report
Asia first time used in the Philippines in
can be used as a reference.
1953, when a dengue attacked children
with bleeding and shock manifestations.2
Case
The national prevalence of Dengue
History, Clinical Finding, and Treatment
Hemorrhagic Fever (based on the diagnosis
A 32 years-old pregnant woman at
of health personnel and respondent's
20 weeks of gestation was admitted to a
complaints) is 0.62%. A total of 12
general hospital complaining of fever
provinces including Aceh have a
(initial Tmax 38.3 C) and was associated
prevalence of Dengue Hemorrhagic Fever
with a mild erythematous skin rash. After
above the national prevalence. In
admission, the patient progressed with
Indonesia, Dengue Hemorrhagic fever was
arthralgia, myalgia, frontal headache, and
first suspected in Surabaya in 1968, but a
nausea or vomiting.
new virological confirmation was obtained
A pregnant woman had fever for 4 days,
in 1970.2 From January to May 2004,
gestational age was 20 weeks with first day
Indonesia faced a dengue fever that deeply
of last menstruation on 12/8/2016 and
disturbed the community and also affected
Estimated Labor Date on 19/5/2017.
the panic of health workers in hospitals and
Antenatal Care at Obsgyn Specialists with
other health facilities as a result of the
ultrasound investigation (ultrasonography)
surging patients. The number of dengue
obtained the fetus in good condition.
fever cases in Indonesia from January to
Patient arrives at the hospital had
May 2004 reached 64,000 (IR 29.7 per
complained of fever for 4 days, fever
100,000 population) with 724 deaths (CRF
disappeared and bursting at night. Patients
1.1%)2
also complained of nausea & vomiting that
was felt since 2 days ago, vomiting more
10 times a day. The movement of the fetus
has been felt this week. No history of other
family members suffering from dengue
fever.
Vital sign finding compos mentis,
blood pressure 90/60 mmHg, pulse rate 88
bpm, respiratory rate 20 tpm, and
temperature was 36,20C.
Obstetric finding we got fundal
height about 2 finger below umbilicus. His
was negative and fetal heart rate was 165
bpm. Genitalia examination there is no
discharge in vulva and uretra. Speculum
examination there are smooth portio, OUE
closed, no fluxus and fluor.
Treatment for patient was IVFD
ringer lactate 20 dpm, neurobion injection 1
amp/ 24 hour, paracetamol 500 mg tid.
DISCUSSION
Pregnant women with dengue
hemorrhagic fever had more risk for
maternal complications. Complications that
can occur in mother is haemostasis
disorders.1,4,5
The diagnosis of dengue
hemorrhagic fever is based on anamnesis,
physical examination and investigation.
Symptom of pregnant women with dengue
hemorrhagic fever is fever. Fever was
caused by inflammation. In addition,
inflammation could lead increase of
permeability resulting circulation and
haemostasis disorder.4,5 There are various
changes in the immunological system in
pregnant woman, so that with the dengue
fever cause pregnant women are
susceptible to various infections and allow
infection to grow into severe.6,7,8
From physical examination the
patient had petechiae in lower extremities
and rumple leed test was positive. Those
caused by blood vessel congestion under
the skin due to the occurrence of plasma
infiltration. Plasma seeps during the course
of the disease from the beginning of the
fever and reaches its peak during shock. In
patients with severe shock, plasma volume
may decrease to more than 30% .9,,10, 11
Patient was observed in Zainoel
Abidin Hospital for 3 days. Treatment
include bed rest, fluid therapy with
crystaloid and drugs for symptoms.
Antipyretics and analgesics for this patient
from class of acetaminophen, eukinin, or
dipiron, but in the use of acetosal should be
avoided cause of its danger of bleeding.
Post treatment and evaluation for 3 days in
hospital, patient had recovered and can be
outpatient for control condition mother and
fetus.
Crystaloid fluid in dengue fever for
circulation fluid volume maintenance and
fluid therapy is the most important for
treatment in this case.10,11
Pregnant woman with dengue fever
need strict monitoring of haemostasis and
fetal condition. Monitoring for vital sign,
Hb, Ht, and platelets every 4-6 hours from
the first day of observation, then every 24
hours.9,10
In our case, fetal was in good
condition. This is consistent with the
experts. Fetus will not influent, but it has a
risk of infection.11,12,13
CONCLUSION
Management of dengue fever in
pregnancy is similar to dengue fever
without pregnancy but in addition we need
more strict monitoring for maternal
heamostasis and fetus condition.
Strict monitoring for vital sign, Hb,
Ht, and platelets every 4-6 hours from the
first day of observation.
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