Malaria in preg

Question 1

Malaria causes

Answer 1

P. Falciparum- 75% of cases (most dangerous)
P.vivax
P.ovale

Question 2

Malaria risks in preg

Answer 2

• Miscarriage
• SB
• SGA
• PTB
• Severe anaemia
• Cerebral malaria
• Placental parasite seqestration

Question 3

Prevention

Answer 3

• Postpone travel plans if possible
• Bite prevention- 50% DEET, netting, clothes etc
• Chemoprophylaxsis
• Diagnosis and rx

Question 4

Presentation

Answer 4

Very non-specific, hx is key.
Presentation up to 1 year from exposure

• Flu like illness +fever
• Abnormal bleeding/ severe anaemia
• Jaundice
• Seizures
• Resp distress

Question 5

Tests

Answer 5

• Thick and thin blood films
• Rapid diagnostic tests (less sensitive)
• If 3x neg smears in 24h, not malaria

Question 6

Prophylaxsis

Answer 6

• HIGH risk pre-concep/1st T
• Causal - Direct to liver schizont stage
  Cont for 7 days after leaving area
• Suppressive (Mefloquine)- Directed against RBC stages, take for 4w after leaving
• Use Mefloquine in 2n and 3rd T

Question 7

SE of meds

Answer 7

• Use mefloquine/chloroquine/proguanil in preg
• Alot of chloroquine resistance
• Doxycycline - bone growth defects
• Primaquine- G6PD def

Question 8

Mx of malaria

Answer 8

• Admit all preg women w malaria
• IV artesunate for severe malaria/ quinine if artesunate not avail.
• P.falciparum- Use quinine and clindamycin
• P. Vivax/ovale/malariae - Chloroquine
• Treat anaemia - slow tx w frusemide
• Blood films every 24h

Question 9

Other symptoms

Answer 9

• Control fever
• LMWH
• CTG to monitor baby
• ITU if needed

Question 10

Care after malaria rx

Answer 10

• ANC
• Growth scans
• High risk of relapse