REPRODUCTIVE HEALTH UNITOBSTETRIC MANAGEMENT PROTOCOLS HOSPITAL/ CENTRAL HOSPITAL MALARIA ANAEMIA IN PREVENTION & MANAGEMENT OF MALARIA IN PREGNANCY PREGNANCY INFECTION ASSOCIATED WITH CAESAREAN SECTION Clinical Features of malaria in pregnancy Definition of mild – Encourage the woman to have a warm moderate ANAEMIA: bath As in non-pregnant adults, malaria in pregnancy may manifest as uncomplicated (severe) disease. Avoid shaving in labour ward The clinical manifestations of malaria in pregnancy are similar to those in adults (fever, feeling Hb between 7 and Practice universal infection prevention cold, shivering, headache, loss of appetite, body malaise, abdominal pains, joint pain, nausea, 11g/dl or PCV between techniques vomiting, diarrhoea 20 and 30% Do proper vaginal examination – 6 swab Management However, pregnant women are at particular risk of hypoglycaemia (especially as a consequence of technique treatment with quinine), anaemia, and immediately after delivery (3rd stage of labour), pulmonary Treat malaria and Provide a clean mackintosh PROPHYLACTIC ANTIBIOTICS oedema. give intermittent Give a single dose of chloramphenicol 1 g presumptive IV OR Ampicillin 2 g IV OR Intermittent Presumptive Treatment of malaria in pregnancy treatment according Cefuroxime 1 g IV to the mother after to protocol the cord is clamped and cut. Intermittent Presumptive Treatment (IPT) of malaria in pregnancy is one of the major Give albendazole THERAPEUTIC ANTIBIOTICS malaria preventive strategies in Malawi. At least two doses of SP, 3tablets for each dose, 400 mg by mouth are given after the first trimester, at least four weeks apart, under direct observation by once after 16 weeks health personnel. gestation Although IPT reduces the risk of malaria in pregnancy, breakthrough clinical malaria Treat proven 8 2 episodes can occur in patients on IPT, as well as in those receiving partial or no IPT. schistosomiasis with 6 MU praziquantel after 240 48 Management of malaria in pregnancy 16 weeks gestation Give iron (200mg po 5 tds) and folic acid Treatment of uncomplicated malaria in pregnancy (5mg) daily by 1 6 48 mouth Uncomplicated malaria Provide dietary
REPRODUCTIVE HEALTH UNITOBSTETRIC MANAGEMENT PROTOCOLS HOSPITAL/ CENTRAL HOSPITAL MALARIA MALARIA IN PREGNANCY ANAEMIA IN PREGNANCY PREVENTION & MANAGEMENT OF INFECTION ASSOCIATED WITH CAESAREAN SECTION Clinical Features of malaria in pregnancy As in non-pregnant adults, malaria in pregnancy may manifest as uncomplicated (severe) disease. The clinical manifestations of malaria in pregnancy are similar to those in adults (fever, feeling cold, shivering, headache, loss of appetite, body malaise, abdominal pains, joint pain, nausea, vomiting, diarrhoea However, pregnant women are at particular risk of hypoglycaemia (especially as a consequence of treatment with quinine), anaemia, and immediately after delivery (3rd stage of labour), pulmonary oedema. Intermittent Presumptive Treatment of malaria in pregnancy Intermittent Presumptive Treatment (IPT) of malaria in pregnancy is one of the major malaria preventive strategies in Malawi. At least two doses of SP, 3tablets for each dose, are given after the first trimester, at least four weeks apart, under direct observation by health personnel. Although IPT reduces the risk of malaria in pregnancy, breakthrough clinical malaria episodes can occur in patients on IPT, as well as in those receiving partial or no IPT. Management of malaria in pregnancy Treatment of uncomplicated malaria in pregnancy Uncomplicated malaria Definition of mild – moderate ANAEMIA: Hb between 7 and 11g/dl or PCV between 20 and 30% Management Treat malaria and give intermittent presumptive treatment according to protocol Give albendazole 400 mg by mouth once after 16 weeks gestation Treat proven schistosomiasis with praziquantel after 16 weeks gestation Give iron (200mg po tds) and folic acid (5mg) daily by mouth Provide dietary Encourage the woman to have a warm bath Avoid shaving in labour ward Practice universal infection prevention techniques Do proper vaginal examination – 6 swab technique Provide a clean mackintosh PROPHYLACTIC ANTIBIOTICS Give a single dose of chloramphenicol 1 g IV OR Ampicillin 2 g IV OR Cefuroxime 1 g IV to the mother after the cord is clamped and cut. THERAPEUTIC ANTIBIOTICS 8 2 6 240 48 5 1 6 48 MU
guidelines_for_malawi_and_tanzania_with_foreword_20.11.13.docx