Malaria: Pregnancy

What happens if the patient vomits?

• Vomiting is a symptom of malaria and a known adverse effect of quinine.
• It is associated with ntimalarial treatment failure.
  If the patient vomits, use an antiemetic. There are no studies of their efficacy in malaria but metoclopramide is considered safe, even in the first trimester. 
• After the antiemetic has had time to take effect, repeat the dose.
• Repeat vomiting after antiemetic is an indication for parenteral therapy.

Other medicationS?

• The fever of malaria has been associated with premature labour and fetal distress
• Prompt treatment with antipyretics (paracetamol at the standard dose) is fundamental to the treatment of fever from malaria in pregnancy. 
• Evidence for the efficacy of paracetamol arises mostly from studies in children.

Does pregnancy affect the efficacy of malaria treatments?

• Treatments in pregnancy may have lower efficacy than in non-pregnant patients but this apparent effect could result from lowered concentrations of antimalarials in pregnancy

Reference:

• The diagnosis and treatment of malaria in pregnancy. RCOG Green-top Guideline No. 54b