MALARIA IN PREGNANCY

BY LORRAINE PATAL –2019

OUTLINE

• Epidemiology
• Cause
• Diagnosis
• Management
EPIDEMIOLOGY

• Malaria is a major public health issue in PNG and other tropical countries.
• Incidence
• It is transmitted by mosquitoes from an infected person to another by a special
species called the anopheles mosquitoes. There are about 400 species of
mosquitoes but 60 are proven malaria vectors
• Anopheles mosquitoes breed in clean, sunlit, slow moving or stagnant water.
 CAUSE AND INCUBATION PERIOD
• A parasite of the genus PLASMODIUM causes
malaria.
• The four common species in PNG are
• Plasmodium Falciparum common in PNG
and African countries
• Plasmodium Vivax – mostly in South East
Incubation period depends on
Asian countries species:
• Plasmodium Malariae – prevails to Latin P.f 9-14 days
P.v & P.o 12-18 days
American countries
P.m 18-40 days
• Plasmodium Ovale – African countries P.k 9-12 days

• Plasmodium Knowlesi
• Plasmodium Falciparum often causes severe symptoms while Vivax,
Ovale and malariae cause mild symptoms.
• P. Vivax and P.Ovale can stay dormant in the liver in hypnozoites
form causing recurrent infection. The activation time can be as short
as 2 months in PNG, however this differs by countries.
MALARIA AND PREGNANCY

• Pregnant women are susceptible to malaria due to the

immunosuppressive effect of pregnancy.
• It is worrying in pregnancy as it can affect both the mother
and the fetus. Some pregnant women may be symptomatic
while others may not, despite carrying parasite in their
blood.
CLINICAL FEATURES

• Fever Other clinical manifestation may

signal severe malaria, which may
• Chills include
• Perspiration  Convulsions
 Drowsiness
• Anorexia  Comma
• Headache vomiting  Hypoglycaemia
 Confusion
• Malaise
• Diarrhoea
 HOW DOES MALARIA AFFECT THE MOTHER AND THE
FETUS?

• Infestated red blood cells

stick to the intervillous space
preventing normal blood flow
from the mother to the fetus.
• This may result in Intra uterine
Growth Restriction or Fetal
Death In Utero.
• It is rare that a newborn can develop neonatal malarial
infection apart from suffering from consequences of
impaired maternal to fetal blood supply.
• Most women who are asymptomatic may carry malaria
parasites in the placenta which usually may not be evident
as peripheral parasitaemia.
DIAGNOSIS

• RDT for malaria parasites is widely recommended in PNG for

diagnosis of malaria
• Microscopy for MP
MANAGEMENT
• Severe malaria in pregnancy
• First trimester
• Artesunate im/iv dly for 7 days plus 2 tabs SP when pt able to
swallow
• Second and third trimester
• Artesunate Im/IV for 7 days
• Second option –arthermeter im inj for 7 days
• Third option – quinine im followed by SP 2 tabs bd for 3 days when
person can swallow,
PREVENTION

• Sleep under treated bed net every night.

• Wear protective clothes
• Chemoprophylaxis ( IPTp –SP) intermittent preventive treatment in
Pregnancy
• (1500mg 3 tabs three times in pregnancy during the second and
third trimester).
COMPLICATIONS

• Fetal – IUGR, FDIU, SFD,

• Maternal – anaemia in pregnancy, PPH complicated malaria, placenta
abruption.
 RDT - MALARIA

1 1 1

T2
Control T1
line
RDT REPRESENTATIONS

• C /line only appears = Negative

• T1 and C line appear =positive for Falciparum
• T2 and C line appear = positive for non Falciparum malaria
• T1 and T2 C lines appear =positive for Falciparum and other malaria
• No lines at all = Invalid
• Lines in T1 and T2 and no line in C = Invalid
• End of session