Severe falciparum malaria in full term pregnancy carries a very high mortality. Maternal and fetal distress may go unrecognised in these patients. Therefore, careful monitoring of maternal and foetal parameters is extremely important and pregnant women with severe malaria are better managed in an intensive care unit. Falciparum malaria induces uterine contractions, resulting in premature labour. The frequency and intensity of contractions appear to be related to the height of the fever.
Fetal distress is common and often unrecognised.
Therefore only monitoring of uterine contractions and fetal heart rate may reveal asymptomatic labour and foetal tachycardia, bradycardia or late deceleration in relation to uterine contractions, indicating fetal distress. Careful fluid management is also very important. In cases of very high parasitemia, exchange transfusion may have to be carried out. If the situation demands, induction of labour may have to be considered. Once the patient is in labour, foetal or matenal distress may indicate the need to shorten the 2 nd stage by forceps or vacuum extraction.