”She was seen at the emergency ward at 28 weeks gestation. She complained of fever which started one week prior to presentation. The fever was intermittent, moderate to high grade”

Emobileclinic Patient’s corner

Emobileclinic Specialist

She was seen at the emergency ward at 28 weeks gestation. She complained of fever which started one week prior to presentation. The fever was intermittent, moderate to high grade. It was worse in the evening and associated with chills and rigors. There was associated generalized body weakness, joint pain and headache. She had been anorexic in the last two days. She felt nauseated but there was no vomiting. There was no abdominal pain or change in the bowel habit. There was no urinary symptoms. There was no cough or chest pain.

She had taken paracetamol and choloroquine tablets during this episodes without improvement. She had experienced similar illness twice in this pregnancy at 16 weeks and 20 weeks respectively. On each occasion, she was given three injections of chloroquine in a private hospital where she had been attending antenatal clinic and the fever resolved .She had not been regular on the antimalarial prophylaxis and the haematinics prescribed in the same hospital because she felt nauseated whenever she took them. She had received one dose of tetanus toxoid.

Her history

She was a primigravida.She attained menarche at the age of 14 years .She menstruated for 5 days in a regular 26- 28 days cycle. The menstrual flow was normal and there was no dysmenorrhea. She had never used any form of contraceptive method before. She was a seamstress and the only wife of her husband who was a civil servant. She did not use insecticide treated net ITN). There was no family history of hypertension, diabetes mellitus, sickle cell disease or twinning. She neither smoked cigarette nor took alcohol containing beverage.

At physical examination, she was acutely ill looking. She was febrile, with a temperature of 38.5 degree C. She was mildly pale, moderately but anicteric. There was no peripheral lymphadenopathy and no pedal oedema. Nothing significant at the other examination.

What could be wrong with her?

Diagnosis

Malaria in pregnancy in an unbooked primigravida at 28 weeks gestation.

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