In Karnataka, a high number of dengue cases have been detected during this year's monsoon season, and doctors are taking precautionary measures to screen pregnant women presenting with fever. Over 9,000 cases of dengue fever have been reported in Karnataka alone, but it is yet to be determined how many of them are pregnant women.
“Dengue fever in pregnant women is something that requires a lot of attention, and given that the season is here, cautionary measures will need to be taken,” says Dr Prashanth Gowda, a senior consultant at Motherhood Hospital in Bengaluru’s Sarjapur.
Dengue fever is a viral infection which spreads from a mosquito bite. The time that the disease takes before symptoms could be anywhere from 4 to 14 days after being bitten. The individual can present with high fever, joint pains and other symptoms of dengue at any time. “Generally, when a pregnant woman presents with a fever, our first instinct is to see whether there is an epidemic,” says Dr Prashant.
“If the woman presents with high-grade fever with signs of flushing of the cheeks and myalgia (fatigue) that has been there for longer than a week, we will subject her to a series of lab investigations to determine the cause of the infection,” he said.
A test is done to check for the presence of the dengue antigen in the body, which is to be done within three days of exposure to the virus. The alternative would be to do another test, called an antibody assessment, to see if the person's immune system is responding to the presence of dengue virus. This can be done three days after a person develops a fever.
If a woman is found to be positive, her haemoglobin and platelet levels will be checked and she will be treated accordingly. Doctors often also recommend that the woman be admitted and monitored routinely to ensure that her blood count remains within normal limits.
“If a woman in the last three months of her pregnancy complains of fever, that becomes a significant cause of concern because it is a crucial stage in the pregnancy and can potentially be fatal to the baby,” says Dr Archana Sampath, a Chennai-based obstetrician and a member of the Federation of Obstetric and Gynaecological Societies of India (FOGSI).
Dengue fever in a pregnant woman is treated with plenty of intravenous fluids and medication to control the fever, just like if the infection were to present in any other individual. Doctors also stress the importance of drinking plenty of water. A decrease in platelets in the blood is normally seen in dengue, but this becomes an additional complication when a pregnant woman contracts the virus.
“The overall condition of the woman appears poor and what we become concerned about immediately is that the resulting dehydration leads to a drop in the amniotic fluid index (AFI),” Dr Prashant.
Amniotic fluid is the fluid that surrounds a foetus while it is growing in the uterus. It’s present in the placenta and provides nutrition to the unborn baby. The AFI is a way for doctors to estimate how much amniotic fluid is present, and a low AFI could indicate that the baby is not getting enough nutrition and can have a severe impact on its growth.
“This, on its own, could be a complicated situation, and can precipitate the onset of labour,” Dr Prashant added.