Managing Complications in Pregnancy and Childbirth: - IAWG

Fever during pregnancy and labourS-105FALCIPARUM MALARIAACUTE, UNCOMPLICATED P. FALCIPARUM MALARIAChloroquine-resistant falciparum malaria is widespread. Resistance toother drugs (e.g. quinine, sulfadoxine/pyrimethamine, mefloquine) alsooccurs. It is, therefore, important to follow the recommended nationaltreatment guidelines. Drugs contraindicated in pregnancy includeprimaquine, tetracycline, doxycycline and halofantrine. Insufficient datacurrently exists on the use of atovoquone/proguanil andartemether/lumefantrine in pregnancy to recommend their use at thistime.AREA OF CHLOROQUINE-SENSITIVE P. FALCIPARUM PARASITES• Give chloroquine base 10 mg/kg body weight by mouth once dailyfor 2 days followed by 5 mg/kg body weight on day 3.Note: Chloroquine is considered safe in all three trimesters ofpregnancy.AREA OF CHLOROQUINE-RESISTANT P. FALCIPARUM PARASITESOral sulfadoxine/pyrimethamine or quinine salt (dihydrochloride orsulfate) can be used for treating chloroquine-resistant malariathroughout pregnancy. Treatment options include:• Sulfadoxine/pyrimethamine 3 tablets by mouth as a single dose;Note: Sulfadoxine/pyrimethamine should not be used if the womanis allergic to sulfonamides.• OR Quinine salt 10 mg/kg body weight by mouth three times perday for 7 days.Note: If compliance with 7 days of quinine is not possible or sideeffects are severe, give a minimum of 3 days of quinine PLUSsulfadoxine/pyrimethamine 3 tablets by mouth as a single dose onthe first day of treatment (providing sulfadoxine/pyrimethamine iseffective; consult the national guidelines).Mefloquine may also be used for treating symptomatic P. falciparum inpregnancy if treatment with quinine or sulfadoxine/pyrimethamine isunsuitable because of drug resistance or individual contraindications.Note: Clinicians should carefully consider the use of mefloquine in earlypregnancy due to limited safety data in the first trimester of pregnancy:• In areas of mefloquine-sensitive parasites, give mefloquine 15mg/kg body weight by mouth as a single dose;