2024 FSA Podium and Poster Abstracts
P088: EMERGENT CESARIAN THROUGH MALARIA: A PERIOPERATIVE CHALLENGE
Tanmai Bandarupalli, BS1; Reine Zbeidy, MD2; 1University of Central Florida College of Medicine; 2University of Miami Miller School of Medicine
Introduction/Background: Pregnancy complicated by malaria, particularly in non-endemic settings, poses significant health risks and challenges in clinical management. Malaria susceptibility increases during pregnancy and contributes to more severe symptoms and outcomes such as miscarriage, premature delivery, and neonatal death. This case discusses the implications of undiagnosed malaria in a pregnant woman at term who required an emergency cesarian section and the unique anesthetic challenges involved. This scenario is particularly pertinent in the context of the United States, where such presentations are uncommon and thus, may not be readily recognizable. This report emphasizes the importance of flexible, anticipatory anesthetic strategies in urgent obstetric procedures as well as a thorough clinical evaluation including a detailed travel history.
Methods: This retrospective case study focuses on clinical presentation, anesthetic strategy, and a multidisciplinary management approach. Diagnostic measures and interventions were guided by the decompensating symptoms, assessment of vital signs and laboratory results, and patient’s travel history. Given the patient’s symptomatic presentation and travel history to Haiti, a high index of suspicion for malaria was maintained. The anesthetic plan involved rapid airway management and general anesthesia to ensure maternal hemodynamic stability in the setting of shock with low uterine perfusion as well as a febrile state. Further, the timeline for treatment of the suspected malaria while managing the emergent cesarean delivery was examined and discussed.
Results: The patient underwent an emergent cesarian section due to fetal distress. The anesthetic approach was tailored to the patient’s febrile condition, with rapid sequence induction utilizing etomidate and succinylcholine. Despite the lack of typical hematologic manifestations of malaria, such as anemia or thrombocytopenia, the anesthetic management preemptively addressed these risks. The neonate was delivered successfully, and no malarial parasites were detected in subsequent evaluations. The patient remained stable in the intensive care unit and the postoperative course included the initiation of empirical antimalarial therapy: quinidine eventually adjusted to chloroquine. This was later confirmed to be appropriate upon positive identification of Plasmodium falciparum in her blood smear.
Discussion/Conclusion: This case demonstrates the necessity for adaptability in anesthetic management during obstetric emergencies, particularly in the face of complex infectious diseases such as malaria. The successful maternal and neonatal outcomes highlight the importance of considering infectious etiologies in patients with relevant travel histories and preemptively incorporating treatment interventions. In this case, prompt, appropriate treatment of empirical antimalarial therapy and rapid anesthetic procedure highlight a unique approach to patient evaluation and treatment in the face of global infectious etiology.