RCOG World Congress 2025

Successful Management of Severe and Complicated Malaria in Pregnancy

Dr Charu Jain, Dr Suguna Balasundaram

Background:

Malaria, a serious and potentially fatal parasitic infection, is the tropical disease most commonly imported into the UK. Pregnant women are at higher risk of acquiring the disease and suffering from more severe complications compared to non-pregnant women, leading to significant maternal, fetal (fetal growth restriction, stillbirth, preterm labour, congenital malaria) and perinatal morbidity and mortality. As a notifiable disease rarely seen in the UK during pregnancy, its diagnosis can be challenging, especially in pregnancy due to sequestration of parasites in placenta. This case is reported to highlight the appropriate maternal and neonatal treatment and follow-up of such a rare occurrence.

Antenatal Management:

Background:

18 year old - African Origin
Recently moved from Nigeria
Late booker
Primigravida
No history of FGM
Symptoms of weakness: Easy fatiguability and Lethargy
Low haemoglobin of 77
Blood films suggested of Plasmodium Falciparum, concentration <0.1%

Diagnosis:

Diagnosed of complicated malaria
Immediate admission
Multidisciplinary team involment
Intravenous Antimalarial treatment
Multiple IV Iron Infussions to build up haemglobin rather than blood transfusion to avoid the risk ofdevelopment of antibodies
Hospital for Tropical disease notified

Follow Up:

Consecutive Blood films (thick and thin)
Repeated blood investigations weekly after discharge
MDT surveillance
Regular Growth scans
Induction of Labour planned at 39 wk gestation
Growth scan showedfetal growth restriction at 37wk
IOL at 37 weeks
Intensive intrapartum monitoring
Baby born vaginally- Eighth centile- required phototherapy for 24 hours

Fetal Managment Plan:

Neonatal Thick and Thin Blood Films - At birth and weekly till 28 days
Placenta for Histology to look for sequestered malarial parasites
Placenta for PCR - 1cm unfixed placental material in saline to Malaria Reference Lab
Placental dab - cut edge of fresh placenta, blotting with sterile gauze, dabbed onto slides and fixed with methanol

Discussion:

Malaria is uncommon in the UK, and even rarer during pregnancy. Managing this rare, complicated case in the hospital was a significant learning experience for the entire department. Key learning points included the practical aspects of the disease, regular monitoring of maternal and fetal well-being through a multidisciplinary approach, interpreting investigations during pregnancy, planning delivery timing, neonatal follow-up, and ensuring the safety of both the patient and the team.

Conclusion:

Managing complicated malaria can be challenging, highlighting the importance of prevention, prompt diagnosis, and treatment. Early multidisciplinary team involvement and continued follow-up can lead to successful outcomes for both mother and baby.

Refrences:

1. Cathcart SJ, Lawrence J, Grant A, Quinn D, Whitty CJ, Jones J, et al. ‘Estimating unreported malaria cases in England: a capture-recapture study’ Epidemiology and Infection 2010; 138(7): 1,052-1,058.

2. UKHSA. ‘Imported malaria in the UK: statistics’ (accessed 27 October 2022).

3. Chiodini PL, Patel D, Goodyer L, Ranson H. ‘Guidelines for malaria prevention in travellers from the United Kingdom, 2022’.

RCOG World Congress 2025

Successful Management of Severe or Complicated Malaria in Pregnancy(Rare in UK)

Poster Presenter

Authors

Affiliations

Part of Topic