Lectures on malaria and pregnancy

2021-03-22 12:00 AM

If the first test results are negative, repeat the test every 3 hours after doing it again (3 tests can be done 3 hours apart).

Malaria is a dangerous disease, especially malignant malaria because it threatens the life of a pregnant woman and her unborn baby. It has been found that the prognosis is often bad for pregnant women compared to malaria. Some opinions suggest that using Quinine to treat malaria is the cause of miscarriage, premature birth but not so, in fact, it is because of high fever, chills leading to uterine contractility, making the fetus ejected. go out. Therefore, in order to reduce the risk to the fetus, it is necessary to reduce fever for the patient. Another cause to note is that the fetus often dies in the uterus due to hypoglycemia, so it should be handled with caution.

Symptoms and diagnosis 

Diagnosis is usually easy in malaria-endemic areas, but the symptoms and complications of malaria are often mixed.

Symptom

The following symptoms can be combined:

High fever, sometimes hypothermia, and dizziness with parasitic infection.

Prolonged coma.

Severe anemia.

Jaundice.

Hemoglobinuria.

Acute renal failure (patients may have oliguria).

Acute pulmonary edema combined with acute respiratory failure, gastrointestinal disturbances (vomiting, ...).

Water disorder, acid-alkaline electrolyte, lactic acidosis.

Hypoglycemia accompanied by severe dizziness.

Hemoptysis dysfunction: often seen scattered blood clots in the lumen.

Superinfection of many organs (often superinfection in the lungs or sepsis).

A definitive diagnosis is often based on the following main symptoms

The coma lasts> 6 hours (after eliminating blood-sugar coma, despite 30-50% Glucoza intravenous transmission, the condition is still in a deep coma).

A peripheral blood test that can distinguish Plasmodium Falciparum parasite> 5% (test 3 times in a row, every 3 hours).

There are no signs of the disease such as meningitis, cerebrovascular accident, hypoglycemia, coma due to acute intoxication; acute alcohol poisoning; typhoid fever.

Diagnosis by administrative level

If pregnant women are in malaria, it is necessary to make a diagnosis based on the symptoms.

At the commune level:

Depressed pregnant women, high fever, bedridden.

Accompanied by consciousness disorder.

Vomiting, sometimes even vomiting medicine.

Bleeding symptoms may be accompanied by bleeding (haematuria, blood diarrhea, subcutaneous bleeding.

At the district level:

In addition to the symptoms mentioned at the commune level, there may also be:

Severe anemia, jaundice, yellow eyes.

Hypothermia, fever, or hypotension.

Urine, electrolyte disorders: edema appears.

At the provincial level:

In addition to the commune and district signs, we need to add the following evidence:

Foci of infection (pneumonia), septicemia.

Acute pulmonary edema, progressive acute respiratory distress syndrome.

Lower blood sugar.

Acute renal failure.

Criteria of subclinical to diagnose parasites at district and provincial levels:

In peripheral blood> 5% of red blood cells have Plasmodium Falciparum. Specific quinine therapy is required, although the incidence of <5% is sometimes <5% of the malaria parasite.

If the first test results are negative, repeat the test every 3 hours after doing it again (3 tests can be done 3 hours apart).

Solving

Often dealing with difficulties; The prognosis is heavy for both mother and fetus. Need to treat in 3 directions:

Specific treatment

At the commune level:

Use quinine 10 mg/kg body weight (8.3 mg of active ingredient) intramuscularly every 8 hours until the patient is able to take the drug. Treatment is continuous for one course (7 days).

Can be replaced with chloroquine 10 mg / kg / 24 hours, total dose 25 mg / kg body weight.

Should be transferred soon to the higher level to continue treatment.

At the district level:

Treatment as commune level.

At the provincial level:

Quinine 10 mg/kg of weight (8.3 mg of active ingredient) in 500 ml of 5% Glucose solution by slow intravenous drip infusion over 4 hours, once every 8 hours. Treatment continuously for 5 days.

Or use chloroquine 5 mg active ingredient/kg weight in 500 ml of 5% Glucose solution infused with slow intravenous drip infusion in about 4-6 hours. Repeat above treatment after 12 hours. Treatment continuously for 5 days.

Daily ECG (Electrocardiogram) measurement for monitoring and management. In the case of QRS dilatation> 12% of a second, the dose of a specific drug for malaria treatment above should be reduced for pregnant women.

Resuscitation for patients

Anti-renal failure with high dose Furosemide: Give 2 to 4 ampoules of Furosemide 20 mg, for early use in the first 48 hours if the patient is anuria. Can use up to> 20 tubes of Furosemide often combined with Dopamine (2 - 5 mcg / kg / min)

If the woman has a high fever> 390C: It is necessary to apply cold compresses, for Paracetamol, Analgin. Do not take aspirin.

Anticonvulsants with PhĂ©nobarbital 0.20g (intramuscularly) or DiazĂ©pam 10mg (intramuscular). If the patient is in a deep coma, it is necessary to insert an endotracheal tube, ventilate a respirator (if possible, depending on the gland) and let the woman lie in an inclined position.

Anti-anemia: Need blood transfusion to pregnant women if the hemoglobin <10g / 100ml, hematocrit <20%. Group fresh blood transfusion or red blood cell transfusion. If a woman has hemoglobinuria, she needs blood transfusion several times and should not be treated with corticosteroids.

Preventing acute respiratory distress and acute pulmonary edema with catheter catheterization measuring CVP (central venous pressure measurement). In addition, the need to limit infusion, should not exceed 1,500ml / 24 hours if CVP> 7 cm H2O. Can be combined with Furosemide 20-40 mg. If pregnant women suffer from acute respiratory failure, it is necessary to insert the endotracheal tube, suck phlegm, and artificial ventilation if possible at the facility.

Nursing work: Needs nourishment and active care by ensuring a complete diet of 2000 calories/day, nourished through the stomach. If the urine is> 1000 ml / 24, hourly the quantity of the solution and food water is 1500-2000 ml. To prevent hypoglycemia from occurring, it is necessary to administer intravenous glucose 30% 500ml / 24 hours. Need to fight ulcers for pregnant women by shaking their bodies often.

Obstetric treatment

Not in labor:

Need medical treatment (a specific drug for malignant malaria), resuscitation against dizziness, and no special intervention in obstetrics and gynecology. Add fever-reducing medicine to avoid uterine contractions.

Signs of labor:

Amniocentesis must be abolished early in order for the delivery to progress quickly, when the fetus has reached the end of the pregnancy, it is eligible to support Forceps to get pregnant; Limited indications for cesarean section if there are no necessary indications. 24/24 hour monitoring of pregnant women (First line nurse) to prevent postpartum bleeding because of possible clotting dysfunction and need to prepare fresh blood from the group, Fibrinogen, Hemocaprol, EACA (Epsilon Amino Caproid Acid) to treat pregnant women. It is necessary to prepare facilities and good regimes to take care of the newborn because mothers with malignant malaria are usually preterm, malnourished, and sometimes stillborn.

Conclusion

Malignant malaria often threatens the health and life of pregnant women and their babies. Obstetric complications such as bleeding, infection also often occur. Therefore, it is necessary to move to higher levels with good conditions for treatment and resuscitation in order to reduce the maternal and newborn mortality rate, contributing to the safe care and management of mothers.