The Tamil Nadu Directorate of Public Health has issued a protocol for the management of fever and infections in pregnant women, which requires these women to be admitted to the hospital for further testing, management and diagnosis to prevent complications and maternal deaths. “Fever during pregnancy should be taken seriously,” stated Dr. T S Selvavinayagam, Director of Health, in a circular sent to district health officials.
In 2023, one out of every twenty maternal deaths in Tamil Nadu was linked to fever and other infections with most deaths occurring within three days of the onset of fever. Out of the 400 maternal mortality cases registered in 2023, 20 women died due to fever or other infections. An analysis by the Directorate of Public Health (DPH) revealed that in most cases, death occurred within three days of the onset of fever symptoms. With the onset of the monsoon, there has been an increase in fever cases across the state, putting vulnerable populations, including pregnant women, at risk. Health officials have been urged to conduct continuous surveillance and screening for early diagnosis and treatment of all pregnant women displaying symptoms of fever or other infections.
According to the instructions, doctors are required to assess pregnant women on the first day of fever and conduct basic investigations such as blood tests for leptospirosis, scrub typhus, sepsis and dengue. If the mother has a fever and a cough, she should be screened for Covid-19, H1N1 and influenza. If jaundice is present, she must be tested for Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV). Treatment must not be delayed, and follow-up appointments within 24-48 hours must be scheduled to monitor the mother’s progress.
Pregnant women should also be educated about warning signs that require immediate medical attention, such as persistent high fever, vaginal bleeding, severe abdominal pain or decreased fetal movement. These measures are intended to help the state reduce maternal mortality.
In Tamil Nadu, approximately 8.78 lakh women deliver each year, with 54 women dying per 1 lakh live births due to various reasons. Maternal death audits conducted by the state since 2004 have revealed that the top five causes of maternal deaths include postpartum hemorrhage (25%), hypertensive disorders (22%), sepsis (10%), heart disease (8%) and abortion (4%). The audits also indicated that 80% of pregnancy-related deaths could have been prevented with strategic pre-birth planning, capacity building, and adequate technical and medical support.