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Severe malaria in a pregnant woman successfully treated with artemisinin-based combination therapy (ACT)

Stephanie Marie S. Aquino, MD and Angela A. Du, MD, FPOGS
Department of Obstetrics and Gynecology, Manila Doctors Hospital

Malaria is suspected in pregnant women with fever of unknown origin who come from areas with high transmission of the disease. Pregnant women are at greater risk of infection due to a weakened immune response and higher parasite burden because of placental sequestration. A 26-year-old Sudanese primigravid 23 6/7 weeks of gestation presented at our institution with mixed infection of malaria, with severe features (hypotension and anemia). Malaria was highly suspected due to her country of origin, which was highly endemic and has high transmission of the disease. Fetal surveillance to monitor fetal well-being was done since malaria is known to cause perinatal adverse outcomes. Intrauterine growth restriction, preterm labor and stillbirth are the most common perinatal morbidity from malaria. These are not present in the patient due to the prompt initiation of artemisinin-based combination therapy, which significantly decreased the parasite load, leading to successful outcome.