Anemia and malaria in pregnancy Flashcards
(19 cards)
Define anemia in pregnancy.
Hb < 11 g/dL → Anemia
Hb < 7 g/dL → Severe anemia
How do you prevent anemia in pregnancy?
Provide all antenatal women with FeFol 325 mg orally twice daily (BD).
Advise on a diet rich in green leafy vegetables, liver, fish, and eggs.
Give Albendazole 400 mg to prevent hookworm.
Give at least 3 doses of SP (each dose: 3 tablets, each tablet 500 mg/25 mg SP) 4 weeks apart, starting at 13 weeks gestation.
Advise to keep the interval between pregnancies > 2 years minimum.
All breastfeeding mothers should take iron supplements.
What the most common causes of anemia in pregnancy?
Iron deficiency and Acute blood loss
How is anemia diagnosed (history, exam, investigations)?
History:
Patient may report easy fatigability, dizziness, headache, palpitations, or PV bleeding.
Exam:
On examination, look for pallor, tachycardia, jaundice, splenomegaly, or petechiae.
Investigations:
Do point-of-care Hb to assess severity immediately, check for malaria (RDT or peripheral smear), send stool for ova and parasites, perform FBC if Hb < 8 g/dL, and test for HIV.
How to manage anemia based on FBC results?
If Hb < 7 g/dL (especially symptomatic) → blood transfusion:
* Rapid if acute blood loss
* Slow if chronic anemia (consider diuretics to prevent heart failure)
Treat with folate and FeFol 325 mg PO BD, recheck Hb in 2–4 weeks
If MCV < 80 → send iron studies (ferritin, TIBC, % saturation)
If MCV 80–93 → peripheral smear + hematology consult
If MCV ≥ 94 → treat for folate or vitamin B12 deficiency
How to treat common causes of anemia?
Albendazole 400 mg once on an empty stomach to prevent hookworm
Treat malaria or schistosomiasis if indicated
Mixed anemia can complicate labs
How to treat iron, folate, and vitamin B12 deficiencies?
Iron deficiency → elemental iron 200 mg PO OD, titrate dose, take on empty stomach with vitamin C, avoid antacids
Folate deficiency → folate 1–4 mg PO OD
Vitamin B12 deficiency → 1000 mcg IM weekly ×4 weeks, then monthly until corrected
How to manage hemolytic anemia?
Send blood for direct and indirect Coombs tests
Treat with corticosteroids
Drug-induced hemolytic anemia (e.g., methyldopa, penicillin, cephalosporins) is milder and treated by stopping the offending drug
Define malaria in pregnancy.
Febrile illness caused by species plasmodium, mostly plasmodium falciparum in our setting
Give 5 maternal and fetal complications of malaria in pregnancy.
Severe anaemia
Preterm birth(<37 weeks gestation)
Low Birth Weight (<2500g at birth)
Abortions
IUGR
Perinatal Death
Placental abruption
Hypoglycaemia when taking quinine
Pulmonary oedema
Cerebral malaria
What are the common signs and symptoms of malaria in pregnancy?
Fever, chills, headache, myalgia, loss of appetite, nausea/vomiting, abdominal pains, uterine contractions, malaise, reduced fetal movements.
What are the signs and symptoms of severe malaria?
Dark colored urine, drowsiness/coma, mental confusion, seizures, jaundice, inability to stand, persistent vomiting, temperature > 39°C, anemia, poor urine output, difficulty breathing, fetal demise.
Which investigations are done for malaria in pregnancy?
Malaria parasite smear, MRDT, FBC, Blood sugar
How is malaria prevented in pregnancy?
Use insecticide-treated mosquito nets.
Give Sulfadoxine-Pyrimethamine (SP) 1500 mg/75 mg (3 tablets of 500 mg/25 mg) starting after 13 weeks (second trimester).
Repeat every 4 weeks until delivery.
Minimum of 3 doses required.
Doses given at least 4 weeks apart as directly observed therapy.
Last dose can be given safely up to delivery.
SP can be taken with or without food.
HIV-positive women on Cotrimoxazole prophylaxis should NOT receive SP.
How do you manage severe anemia close to delivery in malaria patients?
Manage complications as for any adult; consider blood transfusion if severely anemic and close to delivery.
What is the treatment for malaria in the first trimester?
Quinine 600 mg TDS + Clindamycin 300 mg TDS (or 20 mg/kg/day divided into 3 doses) for 7 days.
Panadol 1 g TDS as needed.
For severe malaria: IM/IV Artesunate 2.4 mg/kg at 0, 12, 24 hours, then 3 days of LA when able to take oral meds.
If Artesunate unavailable, use IV Quinine.
If treatment failure, treat with LA.
What is the treatment for malaria in the second and third trimesters?
LA (Lumefantrine 120 mg / Artemether 20 mg): 4 tablets STAT, then again in 8 hours, then BD for 2 days.
Severe malaria: IM/IV Artesunate 2.4 mg/kg at 0, 12, 24 hours, then 3 days of LA when oral meds possible.
If Artesunate unavailable, give IV Quinine.
What is the alternative IV Quinine therapy regimen?
Loading dose: 20 mg/kg IV, then 10 mg/kg every 12 hours for at least 24 hours.
Administer in 10% dextrose infusion or 5% dextrose in normal saline over 4 hours.
If infusion unavailable, give 10 mg/kg IM injection with prior 10% dextrose or 5% glucose.
If patient unweighable, give 900 mg Quinine in 1L 5% dextrose, then 600 mg in 1L every 12 hours.
Switch to oral Quinine + Clindamycin once able to take oral meds.
What precautions should be taken during IV Quinine therapy?
Monitor for hypoglycemia: check random blood sugar before and after Quinine administration.
Monitor for pulmonary oedema; give diuretics and stop fluids if overhydration occurs.
