Book of Medical Disorders in Pregnancy - Tintash

nausea, vomiting, purities and
exfoliative dermatitis. When
administered for prolonged periods, it
may produce lenticular opacities and
retinopathy. The former disappears when
the drug is stopped.
An acute attack of malaria during
pregnancy should be treated promptly.
To patients with severe nausea and
vomiting, chloroquine hydrochloride
should be given parenterally until these
symptoms subside. Severe anemia
should is corrected by blood transfusion.
There is no indication for therapeutic
abortion in these cases. No data is
available with regard to possible
teratogenic effects of chloroquine.
Pyrimethamine is another antimalarial.
This is a folic acid antagonist and may
cause abortion or fetal malformation if
given during early pregnancy.
During pregnancy regular suppressive
therapy should be continued in non
immune patients. It should be started by
the end of the first trimester to prevent
febrile paroxysms. A paroxysm consists
of a chill which lasts for 20 to 60
minutes and high fever which can last
for 1 to 4 hours and profuse sweating.
High fever can cause intrauterine death.
Chronic or latent malaria occurs as a
result of repeated re infections in
endemic areas. It is remarkably well
tolerated by adult populations that have
survived the disease since infancy and
have acquired a high degree of immunity.
Latent malaria may become active
following surgery, during pregnancy, or
after delivery.
To give reliable protection to the fetus,
an increased dose of chloroquine
phosphate i.e. 0.5 gm. every third day is
156
recommended during the month before
term. Suppressive drugs should be given
to exposed infants as soon after birth as
possible. Most antimalarials are secreted
in human milk. It has been suggested
that a 50 per cent increase in the dosage
of suppressive drug given to a nursing
mother can protect the breast feed infant
during the first months of life.
Chemotherapy will usually pre-vent
anaemia when given at the onset of the
disease but will not cure it once it has
developed. Folic Acid 5 milligram daily
should be given by mouth to pre-vent
megaloblastic anemia) but trans-fusion
will be required for severe anemia near
term.
Progressive hemolytic anemia
can often be arrested by giving prednisone,
20 milligram daily by mouth.
Congenital malaria: The parasite can
cross the placenta and cause
"congenital" malaria. Its incidence varies
from 0.03 to 1 per cent. The parasites
have special affinity for the decidual
blood vessels. Infection occurs when the
placenta is damaged. This breaks the
marten fetal barrier. The placental
barrier is often quite effective in immune
patients.
Symptoms: These are fever, vomiting,
convulsions" pallor, jaundice, and
hepatosplenomegaly, which usually
appears in the newborn 48 to 72 hours
after birth. Death may result from acute
pulmonary edema. Passive immunity is
transmitted from mother to child, in
countries where malaria is endemic.
Prophylaxis of congenital malaria
In malarial areas all newborn infants
should be protected by mosquito netting,