Malaria and pregnancy: the perspective in Pakistan.

OBJECTIVE To study the effects of malaria on pregnancy outcome. METHODS A case control study conducted on patients identified by ICD-9 coding system of the hospital medical records. Demographic and clinical data recorded on standardized data sheet and analyzed using SPSS 11.5 software. RESULTS Of the total patients, 67.4% were multigravid and 32.6% were primigravid with 78.6% of patients having platelets < 150,000. Mean haemoglobin was 9.4 gm/dl in patients and 12.2 gm/dl in controls. Plasmodium Vivax was accounted for 55.8%, P. Falciparum for 41.9%, and P. Ovale 2.3% of infections. In all, 48.8% of patients received oral Chloroquine, 16.3% oral Quinine, 30.3% intravenous Quinine, 20.9% of patients received combination treatment with IV Clindamycin, and one each patient received oral Artemether or oral halofantrine. Two patients had an abortion. One of the following complications including, threatened abortion, preterm labour, ARDS or Cerebral malaria, was observed in one patient each. Mean weight of babies born to cases was 2.8 kg (range 1.4-3.8) and of control babies was 3.2 kg (range 2.5-4.0 kg). No congenital malformations were reported. CONCLUSION Plasmodium falciparum sp, moderate parasitic load, haemoglobin < 10 gm/dL, platelet count < 50,000/mm3 and IV quinine with loading dose of 20 mg/kg are identified as few of the potential risk factors for poor outcome in pregnancy.