The document discusses the risks of malaria during pregnancy. Malaria caused by Plasmodium falciparum poses significant threats in Sudan, affecting all age groups and being a major cause of maternal and infant mortality. Pregnant women face higher risks of more frequent and severe malaria episodes than non-pregnant women due to lower immunity. Malaria in pregnancy can lead to numerous maternal complications affecting multiple organ systems as well as adverse pregnancy outcomes like miscarriage, preterm birth, low birth weight, stillbirth, and increased perinatal death and morbidity. Treatment depends on symptoms and gestation but should be carefully selected to avoid fetal side effects.

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2.  Malaria is a major threat to life world-wide
 Mainly plasmodium falciparum in Sudan
 Affects all age groups and is a major cause
of perinatal mortality and maternal
mortality and morbidity
 Malaria is worse in pregnancy than non-
pregnant with higher risks in primigravidas
and more common in the second half of
pregnancy. This is all related to low
immunity
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3.  Maternal complications
 More frequent episodes and relapses
 Increased severity
 Anemia, hemolytic and megaloblastic. May
result in heart failure and splenomegaly
 Allged malaria—malaria with gram
negative septicemia and renal failure
 Hypoglycemia
 Hyper-parasitemia---hemoglobinuria and
metabolic acidosis
 Hyperpyrexia
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4.  Acute renal failure
 Cerebral malaria----convulsions, coma and
death
 Pulmonary edema
 Hepatic failure and jaundice
 D.I.C and bleeding tendency
 Secondary infections----enteric fever,
septicemia
 Dehydration and electrolyte imbalance---
circulatory failure and cardiac arrest
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5.  Miscarriage
 Preterm labour
 Low birth weight and IUGR
 IUFD and fetal hydrops
 Neurological damage
 Increased perinatal death and morbidity
 Transplacental infection-----intrauterine
convulsions, thrombocytopenia, congenital
anomalies, congenital malaria
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6.  Precipitate labour
 Fetal distress
 Post partum hemorrhage and collapse
 Puerperal psychosis
 Hyperpyrexia
 Thromboembolism
 Lactational difficulties
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7.  Exclude diseases simulating malaria and
confirm diagnosis (BF)
 Further investigations according to
severity---CBC, urinalysis, KFTs, LFTs, Serum
glucose, Coagulation profile, USS
 General supportive measures---I.V fluids,
anti-emetics, anti-pyretics, blood
transfusion if necessary
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8.  Choice of drug depends on the presenting
symptoms, severity and gestational age
 Chloroquine
 Safe but not used routinely because of resistance
(vivax, ovale and malaiae not resistant). Rarely
causes fetal retinal damage, cataract and8th nerve
damage
 Quinine
 Safe during all pregnancy and purperium. Can be
given orally or I.V
 Side effects include hypoglycemia, hypotension and
quinism (nausea, vomiting, headache, tinnitus,
delirium)
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9.  Fansidar
 Contains sulphadoxine 500mg and pyrimethamine
25mg
 Should be avoided in the first and late third trimester
because of fetal effects ( pyrimethamine: NTDs,
Cranio- facial defects, fragile x syndrome, mental
retardation. Sulpha: renal agensisis, hemolytic
anemia, kernictrus)
 Artemisinin derivatives
 Artemether, Artesunate and artesumine
(artesunate+sulphadoxine)
 Avoid in first and third trimester
 Mefloquine, primaquine, proguanil tetracycline. All
contraindicated in pregnancy
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10.  Insecticides, mosquito nets, vaccination
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