Malaria in pregnancy lec

2,785 views

Published on

Medical student Lecture

Published in: Education
1 Comment
11 Likes
Statistics
Notes
No Downloads
Views
Total views
2,785
On SlideShare
0
From Embeds
0
Number of Embeds
64
Actions
Shares
0
Downloads
280
Comments
1
Likes
11
Embeds 0
No embeds

No notes for slide

Malaria in pregnancy lec

  1. 1. MALARIA IN PREGNANCY BY Dr Swati Singh Dept. Of Obs & Gyn 1
  2. 2. Malaria Facts • 300 million malaria cases each year worldwide • 9 out of 10 cases occur in Africa • An African dies of malaria every 10 seconds • Affects 5 times as many as TB, AIDS, measles and leprosy combined 2
  3. 3. Malaria and the Obstetric patient • Every minute – About 12 Nigerian women become pregnant (WHO) • All are predisposed to dangers of Mal in Preg – Asymptomatic / Undetected / Untreated * Agboghoroma (31%), Isah (3.1%) • 11% of Maternal death is due to Malaria Nigeria) (NPC/UNICEF - • There are also untoward effects on the unborn child 3
  4. 4. MALARIA Malaria is caused by one of 4 protozoan parasites: Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae Malaria is transmitted through the bite of an infected female Anopheles mosquito 4
  5. 5. Malaria Parasite Life Cycle Host Parasite Infecting vector Infected vector 5
  6. 6. Effects of Pregnancy on Malaria  More common.  Malaria is more common in pregnancy compared to the general population probably due to Immuno suppression and loss of acquired immunity to malaria.  More atypical.  In pregnancy, malaria tends to be more atypical in presentation probably due to the hormonal , immunological and haematological changes of pregnancy.  More severe.  Probably for the same reason, the parasitemia tends to be 10 times higher and as a result, all the complications of falciparum malaria are more common in pregnancy compared to the non-pregnant population. 6
  7. 7. Effects of Pregnancy on Malaria  More fatal  P. falciparum malaria in pregnancy is more severe, the mortality is also double (13 % ) compared to the non-pregnant population (6.5%).  Selective treatment  Some anti malarials are contra indicated in pregnancy and therefore the treatment may become difficult, particularly in cases of severe P. falciparum malaria.  Other problems  Management of complications of malaria may be difficult due to the various physiological changes of pregnancy. 7
  8. 8. Question •What are the effects of malaria on the mother and unborn baby? 8
  9. 9. EFFECTS OF MALARIA ON PREGNANCY [Species, Transmission pattern, Parity & Others]  Abortion – placental sequestration (pl sq)  Anemia  Cerebral malaria  Low birth weight (Prematurity, IUGR) – pl sq  Stillbirth  Congenital infection  Puerperal sepsis  Maternal Mortality 9
  10. 10. Management of malaria in pregnancy involves three aspects that are of equal importance 1. Treatment of the malaria 2. Management of complications 3. Prevention of recurrence 10
  11. 11. TREATMENT OF MALARIA IN PREGNANCY • Depends on severity of the disease - Simple / Uncomplicated - Complicated • Gestational age - First trimester - Second trimester - Third trimester • Aims at bringing attack/pyrexia to an end. 11
  12. 12. QUESTION •How do you differentiate simple malaria from severe malaria in a pregnant woman? 12
  13. 13. Recognizing malaria in pregnant women Uncomplicated malaria • • • • • Fever Shivering/chills Headaches Muscle/joint pains Nausea/vomiting (Can tolerate per os) • False labor pains • + / ++ 13
  14. 14. Recognizing malaria in pregnant women Complicated • Signs of uncomplicated malaria, plus: • Dizziness • Breathlessness • Sleepy/drowsy • Confusion/coma • Sometimes fits, jaundice, severe dehydration • ++ / +++ 14
  15. 15. Simple / Uncomplicated Malaria  1st trimester = Quinine ( safe and evidence-based)  2nd and 3rd trimesters 1st Line = 2nd Line = Arthemeter/Lumefantrine(Coartem) Artesunate + Amodiquine Artesunate + fansider 15
  16. 16. Complicated Malaria  All trimesters!  Quinine     Parenteral, then Orals Loading / maintenance Hypoglycaemia Absolutely safe! 16
  17. 17. Supportive Treatment in Management of Malaria in Pregnancy  Adequate calories  Correction of electrolyte imbalance  Blood transfusion / EBT in acute and severe cases  Oxygen + Diuretics in pulmonary oedema  Anticonvulsants  ICU for CM  Dialysis for ARF  Monitoring of the fetal growth & health  Deceleration & death (Opare Addo) 17
  18. 18. PREVENTION & CONTROL PROGRAMS Available options are:  Vector control  Drug prophylaxis  Vaccination 18
  19. 19. VECTOR CONTROL • Insecticide Treated Nets (ITNs) - Promote growth and development of fetus and newborn - Shulman et al(2000), Isah/Ekele’2006 (?enough) • Residual house hold spraying • Environmental management - Cleanliness is next to Godliness - Drainage and water flow control 19
  20. 20. •All pregnant women should receive at least two doses of IPT after quickening at ANC visits (WHO recommends a schedule of four visits, three after quickening) •Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS •Presently, the most effective drug for IPT is sulfadoxinepyrimethamine (SP) combination 20
  21. 21. 21 Fetal growth velocity  Rx Rx Last month Quickening 10 Conception Source: WHO 2002. 16 20 30 Weeks of gestation Birth 21
  22. 22. • A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg. (Daraprim, the ‘Sunday-Sunday tablet’ is no longer effective) • Healthcare provider should dispense dose and directly observe client taking dose 22
  23. 23. CANDIDATE VACCINE I. PRE- ERYTHROCYTIC VACCINE (SPOROZOITE) 1. Irradiation Attenuated Sporozoite (IAS) 2. Circumsporozoite protein (CSP) Escape of even a single sporozoite leads to failure of anti-sporozoite vaccine II. ASEXUAL BLOOD STAGE VACCINE 1. Merozoite specific antigen (MSA-1) 2. Erythrocyte binding antigen (EBA) III INFECTED RED CELLS Schizont infected cell surface antigen (SICA) 23
  24. 24. CANDIDATE VACCINE IV TRNSMISSION-BLOCKING VACCINES 1. Antigametocyte: Pfs 25; Pfs 230; Pfs 48/45 2. - Antiookinete Interferes with fertilization Prevent maturation of gametocytes Prevent mosquitoes from being infected But no effect on those already infected However even if infection occurs transmission to another individual is prevented Hence: Reduce incidence of malaria & prevent transmission of resistant strains. 24
  25. 25. CANDIDATE VACCINE V. MULTIVALENT/MULTISTAGE VACCINE 1. SPf66 - Developed in Colombia Made of synthetic peptide from 3 sexual blood stage MSA Highly immunogenic & probably predominantly act by cellular mechanism Clinical Trials: Colombia (All age groups): 33.6% efficacy Tanzania (Age 1-5 years): 31% efficacy Gambia (Age 6-11 Months): 0% 25
  26. 26. Conclusion • Malaria during pregnancy has adverse consequences for both mother and the baby • Malaria preventive package includes: – Intermittent preventive treatment with SP during antenatal clinic visits – Use of ITNs throughout pregnancy and in the postpartum period 26
  27. 27. Conclusion • Prevention must be complemented by effective case management of malaria for all women of reproductive age 27
  28. 28. THANK YOU!!! 28
  29. 29. Thank you 29

×