Diagnosis and Management of malaria in pregnancy GTG

Question 1

What is the mortality rate of malaria?

Answer 1

0.5-1.0%

Question 2

Who to suspect malaria in

Answer 2

Flu like Sx/febrile, recent travel to malaria area

Question 3

If returned with 3 weeks what else to consider?

Answer 3

Check infection control measures with micro - risk of other infection avian influenza etc

Question 4

How to Dx malaria?

Answer 4

Thick and thin Peripheral blood film

Question 5

What other Ix should be requested when consider Dx malaria

Answer 5

Thick/thin blood film
Malaria rapid antigen test
FBC
Glucose
U+E
LFT
Blood culture
urine dipstick
+/- stool test, CXR, Obs USS

Question 6

If no evidence of malarial, how to rule out malaria in women with fever?

Answer 6

3 x negative malaria smears 12-24 hours after
Stop prophylaxis until malaria Dx excluded, can restart after excluded

Question 7

Limitation of rapid detection tests?

Answer 7

May miss low parasitaemia
Insensitive to p vivax

Question 8

Which clinical manifestations are consistent with severe malaria?

Answer 8

Prostration
Impaired consciousness
Resp distress
Pulmonary oedema
Multiple convulsion
Circ collapse (shock, BP <90/60)
Abnormal bleeding, DIC
Jaundice
Haemoglobiruia

Question 9

Which lab tests are consistent with severe malaria?

Answer 9

Severe anaemia <8
Thrombocytopenia
Hypoglycaemia <2.2
Acidosis <7.3
Renal impairment Oliguria <0.4ml/kg or creatinine >265
High lactate (correlates with mortality)
Hyperpareasitaemia >2% RBCs
Algid malaria - gram -ve septicaemia
Lumbar puncture

Question 10

Where should women with malaria be managed?

Answer 10

Admit pregnant women with uncomplicated malaria
Complicated → ITU

Question 11

How should severe falciparum malaria be managed?

Answer 11

IV artesunate 2.4mg/Kg 0, 12 , 24 hrs
(or IV clindamycin + quinine)

Question 12

Mgmt Uncomplicated Falciparum

Answer 12

PO Quinine + clindamycin for 7 days

or raiment/malarone

If vomiting → IV

Question 13

1st line management for P vivax, ovale, malariae

Answer 13

Chloroquine

Question 14

How often to check BM when on quinine?

Answer 14

2 hourly - quinine causes hyperinsulinaemia, hypos

Question 15

Why is it important to monitor JVP?

Answer 15

Aim keep right arterial pressure <10cm H20 - prevent pulmonary oedema and ARDS

Pulmonary oedema 50% mortality

Question 16

How to manage severe anaemia?

Answer 16

Transfuse with IV frusemide or exchange transfusion

Question 17

What antimalarial cannot be used in pregnancy?

Answer 17

Primaquine

Question 18

If patient becomes hypotensive, what to consider?

Answer 18

Secondary bacterial infection

Question 19

What obstetric complications can occur with acute symptomatic anaemia?

Answer 19

PTL
FGR
Fetal HR abnormality
Still birth

Prompt Tx can redo e this risk

Question 20

VTE prophylaxis

Answer 20

Consider but review platelets as if falling < 100 consider risk of bleedin

Question 21

How should neonate be investigated for congenital malaria?

Answer 21

Placenta histology
Cord and baby blood films

Weekly blood films for 1 month

Question 22

Congenital malaria is most likely to occur if the mother has malaria at which stage of pregnancy?

Answer 22

Close to delivery 8-33%, may present in 1st weeks to months of life, can cause mortality

Question 23

If episode of malaria in pregnancy, how to manage rest of pregnancy?

Answer 23

Regular AN care
Mat Hb, platelets, glucose and serial growth USS
Ensure women aware risk of replace

Question 24

If Malaria Dx which public bodies should be informed?

Answer 24

Public health authority
Health protection agency