Severe Malaria in Pregnancy
Severe P. falciparum is associated with substantially higher mortality in pregnancy than in non-pregnant women.
Severe malaria in pregnancy can be associated with:
- Hypoglycaemia (more frequent)
- Pulmonary oedema (more frequent)
- Obstetric complications (common)
- Associated infections (common)
- Premature labour
- Stillbirth
- Neonatal death
Severe malaria may also present immediately after delivery. Postpartum bacterial infection is a common complication in these cases.
Treatment
Please refer to the full prescribing information and/or patient information supplied by the relevant marketing authorization holder for your country, as well as local policies and treatment guidelines as they may vary from country to country.
| Recommendation | Treatment |
|---|---|
| Strongly recommended | Injectable artesunate |
| Alternative | Injectable artemether |
| Alternative | Injectable quinine* |
*Quinine is associated with a 50% risk for hypoglycaemia.
Parenteral antimalarial agents should be given to pregnant women with severe malaria at any stage of pregnancy, in full doses without delay.
Supportive care
- Transfer to intensive care
- Blood glucose should be monitored frequently
- Obstetric help should be sought
- Once labour has started, foetal or maternal distress may indicate an intervention, and the second stage might have to be shortened by the use of forceps, vacuum extraction or caesarean section.