Malaria In Pregnancy

Question 1

MALARIA PATHOLOGY

Answer 1

 The infected erythrocytes become rigid, irregular and sticky.
 There is blockage of microcirculation due to the sequestered red cells.
 The infected red cells are broken down. Maternal HIV or Tuberculosis cause
parasitization of the placenta.

Question 2

MALARIA CLINICAL FEATURES

Answer 2

 Maternal effects include a cyclical spiking pyrexia that can be associated
with miscarriage and preterm labor.
 Severe anemia may rapidly develop.
 Hypoglycemia is a common feature and may be severe.
 Pulmonary edema due to abnormal capillary permeability results in high
mortality (about 50%).
 Hemolysis causes jaundice and renal failure.
 Fetal effects include premature delivery and IUFR

Question 3

MALARIA EFFECTS ON FETUS

Answer 3

 Due to high fever or placental
parisitization. The intervillous
spaces become blocked with
macrophages and parasites and
there is diminished placental bloodflow. This is mostly seen with P.
falciparum infection and in the
second half of pregnancy
 Congenital malaria is rare (<5%)
unless the placenta is damaged

Question 4

MALARIA PREGNANCY COMPLICATIONS

Answer 4

Pregnancy complications:
 Abortion
 Preterm labor
 Prematurity
 IUGR
 IUFD

Question 5

MANAGEMENT UNCOMPLICATED MALARIA

Answer 5

 Chloroquin-10mg base/kg PO followed by 10mg/kg at 24 hours and 5mg/kg
at 48 hours.
 For radical cure, primaquin should be postponed until pregnancy is over.
 Parasites resistant to chloroquine should be given quinine (10 mg salt/kg PO
every 8 hours for 7 days) under supervision. Patients with severe anemia
may need blood transfusion.
 The antimalarial drugs when given in therapeutic doses have got no effect on
uterine contractions unless the uterus is irritable.
 Folic acid 10mg should be given daily to prevent megaloblastic anemia

Question 6

MANAGEMENT OF COMPLICATED MALARIA

Answer 6

 Artesunate IV 2.4mg/kg at 0, 12 and 24 hours, then daily thereafter.
 Oral therapy (2mg/kg) is started when the patient is stable.
 Alternatively, Quinine IV followed by oral therapy is given.
 Artesunate acts very fast and resistance is rare, it is as effective as IV quinine
however use is limited in the second or third trimester and only used when
other drugs are found resistance.

Question 7

MALARIA PREVENTION

Answer 7

 Sleeping under pyrethroid-impregnated mosquito nets and electrically heated
mats.
 Chemoprophylaxis: Chloroquine is given unless proved resistant. 300mg
base weekly, 2 weeks before travel and covering the period of exposure and
4 weeks after leaving the endemic zone. Mefloquine 250mg/week is the
alternative drug when chloroquine is found resistant.