Malaria in pregnancy Flashcards
Fetal complications of malaria x5
IUGR
Perinatal death
Preterm birth
Low birth weight
Placenta abruption
Maternal complications of malaria x5
Miscarriage
Severe anemia
Pulmonary edema
Cerebral malaria
Hypoglycemia secondary to quinine
Diagnosis of anemia in pregnancy on history x5
PV bleeding
Headache
Dizziness
Heart palpitations
Easy fatigability
Describe pathogenesis of malaria in pregnancy
Plasmodium express VSA ie Variant surface antigens which allow adhesion to CSA ie chondroitin sulfate A receptors> inflammatory reaction >migration of monocytes and tumor necrosis factors to the intervillous space > placental damage
Why primigravida at risk of more severe complications of malaria
They dont have VSA PAM IgG antibodies
People at risk of severe malaria x3
Young children or infants
Pregnant women
Travelers
Signs of severe malaria x5
Dark urine
Jaundice
Seizures
Confusion
Fetal demise
Coma
Describe what thin and thick film show
Thick - shows parasites density
Thin- identifies parasite species
Investigations for malaria x5
MRDT
RBS
FBC
Smear microscopy
Antigenic determination
Prevention of malaria during pregnancy x2
- ITN
- Sulfadoxine pyrimethamine 3 tablets of 500mg/25mg
Treatment of malaria in first trimester x2
Quinine 6000mg TDS + clindamycin
Treatment in 2nd and 3rd trimester
LA 4 tabs stat, 8hrs then BD x2days
Treatment of severe malaria x2
- Artesunate stat, 12, 24hrs
- LA for 3 days after artesunate
Why is LA preferred over quinine x2
Quinine causes hypoglycemia and crosses the placenta
Treatment of complicated malaria
Quinine dihydrochloride for 4hrs, then 8hrs maintenance dose
Switch to the other treatment depending on trimester
Common causes of anemia in pregnancy x5
Malaria
Iron deficiency
Folate deficiency
Acute blood loss
Physiological anemia
Causes of acute blood loss in early pregnancy x3
Ectopic
Miscarriage
Gestational trophoblastic disease
Causes of acute blood loss in late pregnancy x5
Placenta previa
Placenta abruption
Uterine rupture
Preterm labour
Postpartum hemorrhage
Prevention of anemia x5 include doses
ITN
SP 500/25mg
FeFo 325mg PO BD
Albendazole 400mg
Diet rich in green vegetables
Interval between pregnancy < 2years
Species of plasmodium x5
Falciparum
Ovale
Vivax
Malariae
Knowlesi
Effects of placental malaria x4
Fetal tachycardia/distress
Disturbed maternal fetal flow
Reduced glucose supply secondary to quinine
Interferes with transfer of tetanus antibodies
Contents of LA
120mg Lumefantrine
20mg Artemether
Fetal complications of anemia x5
IUGR
IUFD
Prematurity
Birth asphyxia
Delayed cognitive function
Maternal complications of anemia x5
Miscarriage
Preterm labour
Circulatory shock
Lactation failure
High output cardiac failure
Treatment of iron and folate deficiency x2
Iron- elemental iron 200mg PO OD
Folate- 1to4mg PO OD
