Health

1. Malaria in pregnancy.
 Definitions.
 Pathophysiology
 Complications
 Clinical features.
 Management.

2. Definition.
 Febrile condition caused by a protozoan in
plasmodium species ie plasmodium
falciparum, plasmodium vivax and plasmodium
ovale.
 Transmission occurs through bites of infected
anopheles mosquito
 Plasmodium falciparum is the commonest
species in kenya and it is associated with
significant morbidity and mortality.

3. Pathophysiology.
 The infected RBCs become rigid, irregular and
sticky.
 There is blockage of microcirculaton due to the
squestrated red cells
 The infected red blood cells are broken
down(haemolysis).
 The fetal effects are due to high fever or due to
placental parasitisation
 The intervillous spaces become blocked with
macrophages and parasites leading to diminished
placental blood flow.

4. Effects of malaria on the
mother.
 Anemia due to haemolysis and folic acid
deficiency.
 Hypoglycaemia due to increased glucose
consumption both by the host and the parasites.
Also quinine treatment.
 Metabolic acidosis.
 Jaundice due to hepatic dysfunction and
hemolysis.
 Renal failure due to blockage of renal
microcirculation
 Pulmonary edema and respiratory distress.

5. Effects of malaria on the fetus.
 Increased pregnancy complications such as:
 Abortion
 Preterm labor.
 Prematurity
 IUGR
 IUFD.

6. Effects of pregnancy on
malaria.
 Risk and severity of infection are high due to
immunocompromised state.
 Complications are high.

7. Clinical features.
 Joint pains
 Headaches
 Backaches
 General malaise
 Loss of appetite with
vomitting at times.
 Fever
 Chills rigors
 Abdominal pain accompanied by
diarrhoea or constipation.
 Fever
 Severe headache
 Confusion
 Convulsions
 Coma
 Haematuria
 Renal failure.
 Pulmonary edema.
 Hypoglycaemia.
 Dissemnated intravascular
coagulopathy.
Mild (uncomplicated) Severe(complicated)

8. Diagnosis.
 History of the above symptoms
 Physical examinations
 Investigations
 Blood slide for MPS
 Haemoglobin level-if <5g/dl take blood for
grouping and cross matching.
 Lumbar puncture when indicated to R/O
meningitis
 Blood sugar
 Widal test.

9. Differential diagnosis.
 Meningitis.
 Typhoid.
 HIV infection.
 Urinary tract infection.
 Pneumonia.
 Trypanosomiasis.
 Other viral infections.

10. Management.
 Treatment with oral medications
such as
 Artemisin/halofantrine
combinations.
 Other drugs that can be used
include
 Sulfadoxime/pyrimethamine
combination
 Amodiaquine.
 Quinine
 Take care of the fever.
 Tocolytics to prevent premature
labor.
 Intravenous quinine
 Loading dose 20mg/kg in
5%dextrose infused over 4 hours
 Repeat doses 10mg/kg every 8
hrs
 Discontinue infusion as soon as
patient is able to take orally.
 Take care of the fever
 Tocolytics to prevent premature
labor.
 Folic acid supplementation
 Fluid input and output
monitoring.
Mild. Severe.

11. Prevention.
 Use of treated mosquito nets.
 Routine antimalarial prophylaxis-SP 3 tablets
as a single oral dose in 2nd and 3rd trimesters.
 Use of mosquito repellenta
 Clear stagnant waters and bushes
 Routine folic acid and ferrous sulphate.

12.  Questions.