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2.  Malaria is a major threat to life world-wide
 Mainly plasmodium falciparum in Sudan
 Affects all age groups and is a major cause
of perinatal mortality and maternal
mortality and morbidity
 Malaria is worse in pregnancy than non-
pregnant with higher risks in primigravidas
and more common in the second half of
pregnancy. This is all related to low
immunity
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3.  Maternal complications
 More frequent episodes and relapses
 Increased severity
 Anemia, hemolytic and megaloblastic. May
result in heart failure and splenomegaly
 Allged malaria—malaria with gram
negative septicemia and renal failure
 Hypoglycemia
 Hyper-parasitemia---hemoglobinuria and
metabolic acidosis
 Hyperpyrexia
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4.  Acute renal failure
 Cerebral malaria----convulsions, coma and
death
 Pulmonary edema
 Hepatic failure and jaundice
 D.I.C and bleeding tendency
 Secondary infections----enteric fever,
septicemia
 Dehydration and electrolyte imbalance---
circulatory failure and cardiac arrest
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5.  Miscarriage
 Preterm labour
 Low birth weight and IUGR
 IUFD and fetal hydrops
 Neurological damage
 Increased perinatal death and morbidity
 Transplacental infection-----intrauterine
convulsions, thrombocytopenia, congenital
anomalies, congenital malaria
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6.  Precipitate labour
 Fetal distress
 Post partum hemorrhage and collapse
 Puerperal psychosis
 Hyperpyrexia
 Thromboembolism
 Lactational difficulties
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7.  Exclude diseases simulating malaria and
confirm diagnosis (BF)
 Further investigations according to
severity---CBC, urinalysis, KFTs, LFTs, Serum
glucose, Coagulation profile, USS
 General supportive measures---I.V fluids,
anti-emetics, anti-pyretics, blood
transfusion if necessary
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8.  Choice of drug depends on the presenting
symptoms, severity and gestational age
 Chloroquine
 Safe but not used routinely because of resistance
(vivax, ovale and malaiae not resistant). Rarely
causes fetal retinal damage, cataract and8th nerve
damage
 Quinine
 Safe during all pregnancy and purperium. Can be
given orally or I.V
 Side effects include hypoglycemia, hypotension and
quinism (nausea, vomiting, headache, tinnitus,
delirium)
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9.  Fansidar
 Contains sulphadoxine 500mg and pyrimethamine
25mg
 Should be avoided in the first and late third trimester
because of fetal effects ( pyrimethamine: NTDs,
Cranio- facial defects, fragile x syndrome, mental
retardation. Sulpha: renal agensisis, hemolytic
anemia, kernictrus)
 Artemisinin derivatives
 Artemether, Artesunate and artesumine
(artesunate+sulphadoxine)
 Avoid in first and third trimester
 Mefloquine, primaquine, proguanil tetracycline. All
contraindicated in pregnancy
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10.  Insecticides, mosquito nets, vaccination
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