Disease progression and inter-hospital transfer in pregnant women with dengue: A retrospective study in Vietnam.

Dengue in pregnancy is difficult to manage because warning signs, thrombocytopenia, hematocrit changes, and bleeding risk may overlap with pregnancy-related physiology and obstetric conditions. Data on in-hospital progression and transfer from maternity hospitals in dengue-endemic settings remain limited. This retrospective observational study included pregnant women admitted to Hung Vuong Hospital, Ho Chi Minh City, during 2018-2022 with acute dengue confirmed by positive nonstructural protein 1 antigen and/or dengue immunoglobulin M. Dengue severity was reclassified using World Health Organization 2009 criteria. Outcomes were in-hospital disease progression, inter-hospital transfer, and maternal/fetal-neonatal outcomes among women who were not transferred. Analyses were descriptive with exploratory group comparisons and selected crude odds ratios (ORs). Eighty-seven women were included. Median gestational age at admission was 35.5 weeks, and 79 (90.8%) had dengue without warning signs at admission. Disease progression occurred in 32 women (36.8%), 9 (10.3%) met severe dengue criteria, and 30 (34.5%) required transfer. Disease progression (crude OR, 3.66; 95% confidence interval, 1.44-9.30) and warning signs at admission (crude OR, 6.88; 95% confidence interval, 1.29-36.54) were associated with transfer. Among 57 non-transferred women, 9 (15.8%) had admission-captured composite adverse outcomes. Dengue in pregnancy was associated with in-hospital progression and frequent transfer. Transfer should be interpreted as a clinical-system outcome reflecting both severity and the need for coordinated obstetric and adult infectious-disease care.