Evaluate and test pregnant women with fever to reduce maternal deaths, orders DPH

With fever and other infections being the cause for 5% of the maternal deaths during 2023-2024, the Directorate of Public Health (DPH) and Preventive Medicine has instructed all District Health Officers (DHO) to ensure that all pregnant women having fever were fully evaluated, and all basic investigations were carried out at the earliest.

Any pregnant woman with a history of fever should be compulsorily admitted to a healthcare facility for investigations and management.

T.S. Selvavinayagam, Director of Public Health, issued guidelines on managing antenatal women with symptoms of fever. He said that according to an analysis of maternal deaths during 2023-24, of the 400 deaths, 20 were due to fever and other infections, while the time gap between the fever and maternal death was only two to three days. So, proper follow-up was required for pregnant women with symptoms of fever.

He said that fever during pregnancy should not be taken lightly. Pregnant women having fever should be fully evaluated on the first day, and all basic investigations such as complete blood count, tests for dengue NS1/IgM/IgG, leptospirosis, scrub typhus and sepsis should be carried out. If a pregnant woman presents with symptoms of fever with cough, she should be tested for upper respiratory infections such as COVID-19/H1N1 and seasonal flu, he added.

He further said that doctors should check for Hepatitis E/Hepatitis A virus if jaundice was detected. All investigations should be carried out at the earliest, and appropriate medications should be started early. All DHOs and block medical officers were told to immediately check the temperature, heart rate, blood pressure and respiratory rate if any pregnant woman reported with a history of fever, and admit them.

They should ensure that the woman is adequately hydrated, and review her medical history, including any underlying condition or recent illness. They should monitor the foetal well-being through ultrasound. Depending on the severity and cause of fever, they should schedule a follow-up appointment within 24-48 hours to monitor the woman’s progress and ensure that the fever subsides. They should educate the woman on warning signs that require immediate medical attention, such as persistent high fever, vaginal bleeding, severe abdominal pain or decreased foetal movement.

The DHOs were asked to strictly adhere to the instructions to reduce maternal mortality ratio in their respective health unit districts.