Malaria in pregnancy

Question 1

Fetal complications of malaria x5

Answer 1

IUGR
Perinatal death
Preterm birth
Low birth weight
Placenta abruption

Question 2

Maternal complications of malaria x5

Answer 2

Miscarriage
Severe anemia
Pulmonary edema
Cerebral malaria
Hypoglycemia secondary to quinine

Question 3

Diagnosis of anemia in pregnancy on history x5

Answer 3

PV bleeding
Headache
Dizziness
Heart palpitations
Easy fatigability

Question 4

Describe pathogenesis of malaria in pregnancy

Answer 4

Plasmodium express VSA ie Variant surface antigens which allow adhesion to CSA ie chondroitin sulfate A receptors> inflammatory reaction >migration of monocytes and tumor necrosis factors to the intervillous space > placental damage

Question 5

Why primigravida at risk of more severe complications of malaria

Answer 5

They dont have VSA PAM IgG antibodies

Question 6

People at risk of severe malaria x3

Answer 6

Young children or infants
Pregnant women
Travelers

Question 7

Signs of severe malaria x5

Answer 7

Dark urine
Jaundice
Seizures
Confusion
Fetal demise
Coma

Question 8

Describe what thin and thick film show

Answer 8

Thick - shows parasites density
Thin- identifies parasite species

Question 9

Investigations for malaria x5

Answer 9

MRDT
RBS
FBC
Smear microscopy
Antigenic determination

Question 10

Prevention of malaria during pregnancy x2

Answer 10

1. ITN
2. Sulfadoxine pyrimethamine 3 tablets of 500mg/25mg

Question 11

Treatment of malaria in first trimester x2

Answer 11

Quinine 6000mg TDS + clindamycin

Question 12

Treatment in 2nd and 3rd trimester

Answer 12

LA 4 tabs stat, 8hrs then BD x2days

Question 13

Treatment of severe malaria x2

Answer 13

1. Artesunate stat, 12, 24hrs
2. LA for 3 days after artesunate

Question 14

Why is LA preferred over quinine x2

Answer 14

Quinine causes hypoglycemia and crosses the placenta

Question 15

Treatment of complicated malaria

Answer 15

Quinine dihydrochloride for 4hrs, then 8hrs maintenance dose
Switch to the other treatment depending on trimester

Question 16

Common causes of anemia in pregnancy x5

Answer 16

Malaria
Iron deficiency
Folate deficiency
Acute blood loss
Physiological anemia

Question 17

Causes of acute blood loss in early pregnancy x3

Answer 17

Ectopic
Miscarriage
Gestational trophoblastic disease

Question 18

Causes of acute blood loss in late pregnancy x5

Answer 18

Placenta previa
Placenta abruption
Uterine rupture
Preterm labour
Postpartum hemorrhage

Question 19

Prevention of anemia x5 include doses

Answer 19

ITN
SP 500/25mg
FeFo 325mg PO BD
Albendazole 400mg
Diet rich in green vegetables
Interval between pregnancy < 2years

Question 20

Species of plasmodium x5

Answer 20

Falciparum
Ovale
Vivax
Malariae
Knowlesi

Question 21

Effects of placental malaria x4

Answer 21

Fetal tachycardia/distress
Disturbed maternal fetal flow
Reduced glucose supply secondary to quinine
Interferes with transfer of tetanus antibodies

Question 22

Contents of LA

Answer 22

120mg Lumefantrine
20mg Artemether

Question 23

Fetal complications of anemia x5

Answer 23

IUGR
IUFD
Prematurity
Birth asphyxia
Delayed cognitive function

Question 24

Maternal complications of anemia x5

Answer 24

Miscarriage
Preterm labour
Circulatory shock
Lactation failure
High output cardiac failure

Question 25

Treatment of iron and folate deficiency x2

Answer 25

Iron- elemental iron 200mg PO OD
Folate- 1to4mg PO OD