Book of Medical Disorders in Pregnancy - Tintash

sporozoite stage. The main
characteristics of malaria are periodic
fever, splenomegaly and pancytopenia.
Incubation period is 10 to 40 days.
Chemoprophylaxis cans lengthen this
period. Onset of fever is sudden; this
starts with a shaking chill and is then
followed by a marked rise in temperature.
Spike of temperature lasts for several
hours and is accompanied by profuse
sweating. The temperature pattern can be
irregular or continuously high during the
first few days. The febrile paroxysms
later on become periodic with intervals
of 48 hours in P. vivax and P. ovale.
This interval is 72 Hours in P. malariae.
The fever spike in malaria coincides
with schizont rupture and the release of
merozoite, at the completion of the
erythrocytic cycle. In P. falci-parum
malaria, parasite development is usually
asynchronous and the fever may be
continuous or several spikes may occur
in a single day. Other common
symptoms include headache, malaise,
myalgia, anorexia and vomiting.
Between febrile paroxysms, patients
usually feel quite well.
Effect of pregnancy on malaria -
Pregnancy aggravates acute attack and
increases the frequency of "cerebral"
malaria. Labor activates "latent" malaria
and intensifies the effect of an existing
attack. The patient may even collapse
following delivery and die. Rupture of
an enlarged malarious spleen can occur
during labor. Patients with high degree
of immunity show no increase in the
incidence of abortion.
Effect of malaria on pregnancy - In
first trimester, hyperpyrexia may cause
abortion while later on it may result in
intra-uterine death, premature labour, or
neonatal death. Rapid red cell hemolysis
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can produce folic acid deficiency and
megaloblastic anaemia. Parasites along
with macrophages can accumulate in the
placenta and the intervillous spaces and
block them. The growth of the foetus can
be severely affected resulting in
intrauterine growth retardation or death.
Most frequent cause of stillbirth among
infants of mothers with malaria is
intrauterine asphyxia due to placental
edema, necrosis and hemorrhage.
Albuminuria is commonly found in
pregnancies complicated with malaria;
Con. evulsions and coma may also occur
and thus confuse this disease with
eclampsia. Detection of numerous
parasites in the blood with a normal or
low blood pressure in cerebral malaria
can help to differentiate this condition
from eclampsia.
Diagnosis - Apart from history and
clinical features, this can be done by
examination of the red blood cells in a
thick blood smear which will reveal
parasites in over 90 per cent of the active
cases.
After delivery" the placenta and cord
blood should be examined for plasmodia
in all patients. (Nspite of repeated claims
of complete malarial eradication in the
country, one finds positive bloods films
for malarial parasites in pyrexial
pregnant women.
Treatment - The drug of choice in acute
attack is Chloroquine phosphate. This is
administered orally in stat dose of 1 g
and then followed by 0.5 gm. daily for 3
days. In critically ill patients and in.
newborn infants, intramuscular route is
preferred. Symptoms often subside in 24
hours and Parasitemia in 72 hours.
Chloroquine may cause headache,