Dengue haemorrhagic fever in late pregnancy causing maternal and intrauterine foetal death – A case report

Dengue during pregnancy carries a higher risk of maternal and foetal complications, either through haemodynamic instability from disruption of the placental perfusion or through vertical transmission to the foetus.

A previously healthy 29-year-old primigravidae with a POA of 34 weeks presented with one day fever to a tertiary hospital. NS 1 antigen for dengue was positive. She entered the critical phase the following day and her platelet count dropped to 3000/ml by day 3. Intra uterine death was diagnosed on day 4. She continuously deteriorated and died on day 7. At autopsy, gross bleeding manifestations were noted in the mother, along with bilateral pleural effusions, massive sub endocardial haemorrhages and an enlarged liver with sub capsular haemorrhages. The placenta was devoid of any haemorrhages or infarcts. Sub-aponeurotic and subarachnoid haemorrhages and 50ml of blood within the thoracic and peritoneal cavities were found in a mature female foetus with minimal signs of maceration. Laboratory confirmation of foetal dengue virus infection was not possible.

This is a rare case where fatal haemorrhagic manifestations were seen in both the mother and the foetus suggesting vertical transmission. The autopsy findings highlight the unpredictable haemodynamic changes in the uterine circulation which severely hinder dengue management during pregnancy. Dengue infection, especially in late pregnancy, can lead to unpredictable fatal outcomes. The potential benefit of performing an emergency caesarean in such cases should be further explored.