This document discusses malaria in pregnancy, including its definitions, pathophysiology, complications, clinical features, management, and prevention. Malaria is caused by plasmodium parasites transmitted via mosquito bites and can cause severe anemia, hypoglycemia, and other complications in both the mother and fetus. Symptoms range from fever and joint pains to seizures and coma. Diagnosis involves blood smears and treatment depends on severity, ranging from oral medications to intravenous quinine and tocolytics. Prevention focuses on mosquito nets, antimalarial prophylaxis, repellents, source reduction, and supplementation.

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.