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Emergent Cesarean Section in a Patient with Newly Diagnosed Malaria
Abstract Number: S-67
Abstract Type: Case Report/Case Series
Malaria in pregnancy is a life-threatening condition with increased morbidity and mortality for both the mother and the fetus. In this report, we describe the perioperative management of a multiparous woman with a new diagnosis of Plasmodium Falciparum infection who required an emergent caesarian section under general anesthesia. On admission, treatment with quinine and clindamycin was started and her initial laboratory workup included thrombocytopenia with a platelet count of 63,000. In addition, our patient had just traveled into the country from Africa, did not speak English, and a translator was not immediately available. Electronic fetal monitoring revealed prolonged heart rate decelerations with a duration over seven minutes, and our patient was emergently taken to the operating room for surgery.
This report reviews the effect of malaria on multiple organ systems during pregnancy as well as its anesthetic implications. We will discuss the potential pitfalls in the provision of both general and regional anesthesia in this circumstance. The antimalarial drug quinine and its pharmacologic properties and implications in anesthesia are investigated and will be accompanied by a discussion of additional treatment modalities for malaria in pregnancy. Further, we will discuss the ethical and logistical concerns that a language barrier can present in the provision of labor analgesia and in the setting of an emergency cesarean section.