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PREGNANCY
Dr. Frank Ani
Dept. of Obstetrics and Gynecology.
PRESENTATION OUTLINE
INTRODUCTION
EPIDEMIOLOGY
TERMINOLOGIES
AETIOPATHOGENESIS
EFFECT OF PREGNANCY ON MALARIA
EFFECT OF MALARIA ON PREGNANCY
MODE OF TRANSMISSION
DIAGNOSTIC TECHNIQUES
TREATMENT
CONCLUSION
INTRODUCTION
Oocyst
Sporozoites
Mosquito Salivary
Zygote Gland
Red Blood
Cell Cycle
EPIDEMIOLOGICAL TERMINOLOGIES OF MALARIA
ENDEMICITY
- Risk of getting malaria is present all year round
EPIDEMIC
-Risk of getting the disease may disappear or remain insignificant for a
long time with sudden reappearance with bouts of disease.
Transmission is intermittent.
HOLOENDEMICITY
-There is intense all year transmission of malaria parasite with high
population immunity.
HYPERENDEMIC
-Seasonal transmission which do not provide adequate immunity .
TERMINOLOGIES CONT.
Mesoendemic
-some malaria transmission with occasional epidemics providing low
immunity.
Hypoendemic
When there is limited malaria transmission, with little or no immunity
Gametocytes- Is the sexual stage of malaria parasite present in the host RBC
Cure- Is the total elimination of the symptoms and asexual blood stage of the
malaria parasite that caused the patient to seek treatment
CONT.
More common
Malaria is more common in pregnancy compared to the
general population probably due to Immunosuppression and
loss of acquired immunity to malaria during pregnancy.
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 parasitaemia tends to be 10
times higher and as a result, all the complications of malaria
are more common in pregnancy compared to the non-pregnant
population.
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%).
More problems
Management of complications of malaria may be difficult due to the
various physiological changes of pregnancy.
EFFECTS OF MALARIA ON
PREGNANCY
MATERNAL
Worst amongst non-immune, primigravida, sickle cell disease and
Immunocompromised women.
Complicated
• Signs of uncomplicated malaria with:
• Dizziness
• Breathlessness
• Sleepy/drowsy
• Confusion/convulsion/coma
• Jaundice, dehydration
• Blood film ++ / +++
LABORATORY DIAGNOSTIC
TECHNIQUES FOR MALARIA
Anaemia
Cerebral malaria
Stillbirth /IUFD
Congenital infection
Haemoglobinuria/Puerperal pyrexia
Neonatal/Maternal Mortality
Hypoglycaemia
Management of malaria in pregnancy
involves three aspects that are of equal
importance
2. Management of complications
3. Prevention of recurrence
TREATMENT OF MALARIA IN
PREGNANCY
• Gestational age
- First trimester
- Second trimester
- Third trimester
2. IM Artemether
3. IM or IV Quinine
SUPPORTIVE TREATMENT IN MANAGEMENT
OF MALARIA IN PREGNANCY
Drug prophylaxis
Vaccination
VECTOR CONTROL
Insecticide Treated Nets (ITNs)
Environmental management
• Although she may not have symptoms, malaria can still affect
her and the unborn child by impairing its growth
7. 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
New recommendations for
Mefloquine use in pregnancy.
The Centers for Disease Control and Prevention (CDC) now
recommends the antimalarial drug mefloquine for pregnant
women both as a malaria treatment option and as an option to
prevent malaria infection for all trimesters.