Treatment of Severe Malaria in Pregnancy

Treatment

Parenteral artesunate is the recommended treatment for severe malaria in all the trimesters of pregnancy.
Refer to Section on management of severe Malaria above.

Note: Random blood glucose should be measured before and after quinine administration

Shift to LA as soon as the patient is able to take oral medication and at least 24 hours of parenteral therapy has been administered (refer to malaria treatment guidelines for details)
Special attention must be paid to anaemia, hypoglycaemia and pulmonary oedema

See below for further information on the management of complications

Box 4: Management of Complications (See The 8-8-8 Schedule)

Manage complication as for any adult. Of special importance in pregnancy are:

Pulmonary oedema: careful fluid management, diuretics if necessary, oxygen if possible, nurse patient in semi- upright position.
Hypoglycaemia: consider this complication if there is altered consciousness or seizure.
Treat as in Item 2 in Box 2.
Anaemia: be prepared for blood transfusion, especially if the patient is close to parturition. Otherwise, indications for blood transfusion are the same as in others - (see Box 2).
Acute kidney injury: a particular danger if there has been eclampsia or shock. Identification and management as above.
Shock: consider concealed haemorrhage, continuing blood loss, and septicaemia. Pay special attention to fluid needs. Culture blood if possible. Administer broad spectrum antibiotics in addition to quinine.