Malaria - The obstetrician's dilemma: malaria in pregnancy: treatment problems

ABSTRACT

Malaria in pregnancy is a common parasitic infection in Uganda and East Africa in general. The severity of infection depends on the patients immune status; and is worse in the primigravidae and the non-immune migrating to endemic areas. It may produce intrauterine growth retardation or complications in the mother such as cerebral malaria; acute pulmonary oedema; renal failure and in some cases is responsible for several autoimmune phenomena. A number of drugs have been used as the mainstay of treatment but the picture has become complicated by the emergence of resistant strains. Some drugs such as the sulphonamides and trimethoprim which would be useful in overcoming this resistance are unsuitable for use especially in late pregnancy because of adverse effects on the newborn. Newer drugs such as halofantrine and artemisinin (and other ginghaosu derivatives) have been tested and found to be effective against chloroquin resistant malaria. They have unfortunately been found to have either embryotoxic or gonadotoxic effects in laboratory animals. Ethical problems limit the ability of researchers to assess these adverse effects in clinical practice in obstetrics; thus presenting the obstetricians with a clinical dilemma in resistant forms of the disease