Managing Complications in Pregnancy and Childbirth: - IAWG

S-56 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressurePregnant women with severe malaria are particularly prone tohypoglycaemia, pulmonary oedema, anaemia and coma.ANTIMALARIAL DRUGSQuinine remains the first line treatment in many countries and may besafely used throughout pregnancy. Where available, artesunate IV orartemether IM are the drugs of choice in the second and thirdtrimesters. Their use in the first trimester must balance their advantagesover quinine (better tolerability, less hypoglycaemia) against the limiteddocumentation of pregnancy outcomes.QUININE DIHYDROCHLORIDELOADING DOSE• Infuse quinine dihydrochloride 20 mg/kg body weight in IV fluids(5% dextrose, normal saline or Ringer’s lactate) over 4 hours:- Never give an IV bolus injection of quinine;- If it is definitely known that the woman has taken an adequatedose of quinine (1.2 g) within the preceding 12 hours, do notgive the loading dose. Proceed with the maintenance dose (seebelow);- If the history of treatment is not known or is unclear, give theloading dose of quinine;- Use 100–500 mL IV fluids depending on the fluid balance state.• Wait 4 hours before giving the maintenance dose.MAINTENANCE DOSE• Infuse quinine dihydrochloride 10 mg/kg body weight over 4hours. Repeat every 8 hours (i.e. quinine infusion for 4 hours, noquinine for 4 hours, quinine infusion for 4 hours, etc.).Note: Monitor blood glucose levels for hypoglycaemia every hourwhile the woman is receiving quinine IV (page S-55).• Continue the maintenance dosing schedule until the woman isconscious and able to swallow and then give: