Managing Complications in Pregnancy and Childbirth: - IAWG

Fever during pregnancy and labourS-103• If urine culture is unavailable, treat with antibiotics until thewoman is fever-free for 48 hours (page C-35):- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours.• Once the woman is fever-free for 48 hours, give amoxicillin 1 g bymouth three times per day to complete 14 days of treatment.Note: Clinical response is expected within 48 hours. If there is noclinical response in 72 hours, re-evaluate results and antibioticcoverage.• For prophylaxis against further infections, give antibiotics bymouth once daily at bedtime for the remainder of pregnancy and for2 weeks postpartum. Give:- trimethoprim/sulfamethoxazole 1 tablet (160/800 mg);- OR amoxicillin 250 mg.• Ensure adequate hydration by mouth or IV.• Give paracetamol 500 mg by mouth as needed for pain and to lowertemperature.• If there are palpable contractions and blood-stained mucusdischarge, suspect preterm labour (page S-122).UNCOMPLICATED MALARIATwo species of malaria parasites, P. falciparum and P. vivax, accountfor the majority of cases. Symptomatic falciparum malaria in pregnantwomen may cause severe disease and death if not recognized andtreated early. When malaria presents as an acute illness with fever, itcannot be reliably distinguished from many other causes of fever onclinical grounds. Malaria should be considered the most likelydiagnosis in a pregnant woman with fever who has been exposed tomalaria.• Women without pre-existing immunity to malaria (living in nonmalarialarea) are susceptible to the more severe complications ofmalaria (page S-52).• Women with acquired immunity to malaria are at high risk fordeveloping severe anaemia and delivering low birth weight babies.