In Thailand's Prapokklao Regional Hospital, improved care and monitoring have led to the prevention of death among pregnant women with malaria. The methods used to combat the disease and its principal complications are outlined below.
PIP: Beginning in 1981, Prapokklao Regional Hospital in Chantaburi, Thailand, admitted all pregnant women with malaria to the obstetrics unit so midwives and obstetricians could learn how to better detect early signs or symptoms of malaria. Prior to 1981, they treated these women with quinine hydrochloride in a 500 ml 5% dextrose drip for 8 hours. They failed to detect hypoglycemia and pulmonary edema, however, resulting in many deaths. After 1981, they used 20 mg/kg quinine hydrochloride in a 250 ml 5% dextrose drip in 4 hours then 10 mg/kg quinine hydrochloride in a 250 ml 5% dextrose drip at the same rate at 8 hour intervals. Once the patient could take the drug orally, they administered 600 mg quinine sulfate at 8 hourly intervals for 7 days. They measured blood bilirubin levels and performed renal function tests on admission and on days 2 and 5. They monitored blood sugar levels on admission, at hourly intervals during intravenous quinine treatment, and every 4 hours during oral quinine treatment. Clinicians encouraged women who could drink to drink glucose syrup during quinine treatment. If, during treatment, a patient experienced unconsciousness or convulsions or blood sugar levels fell below 60 mg/dl, they would administer 100 ml of 50% glucose. If bilirubin levels remained high or a patient became jaundiced on day 2, clinicians monitored bilirubin on days 3 and 4. If levels increased, they reduced the dose 33% until the situation improved. They recorded urinary output hourly and measured central venous pressure. If the patient had normal pressure, but urinary output was less than 30 ml/hour, clinicians prescribed a diuretic. They kept patients in a propped-up position to reduced the likelihood of pulmonary edema. They monitored fluid intake and output and, in severe cases, central venous pressure. They allowed just enough fluid intake to maintain the pressure at 10-12 mm H20 and urine output at no less than 30 ml/hour. These efforts reduced maternal deaths in the unit from 341 to 54/100,000 live births (1981 - 8 deaths; 1986 - no deaths).