Patient selection: pregnant woman with Plasmodium infection
Pathogenesis: accumulation of infected red blood cells in the placental intervillous space (expression of VAR2CSA protein allows binding to chondroitin sulfate A in the intervillous space)
Other histologic features:
(1) monocytes in the intervillous spaces
(2) malarial pigment accumulation in fibrin, syncytiotrophoblasts and stroma
Factors affecting severity:
(1) inflammatory response
(2) timing of the infection relative to gestationl age
(3) parasite burden
(4) primigravida (risk greater than for > 2 previous pregnancies)
(5) HIV-positivity
Complications:
(1) stillbirth
(2) low birth weight and/or small-for-gestational age (intra-uterine growth retardation)
(3) preterm delivery
(4) maternal anemia
Antimalarial therapy can reduce the parasite load but selection needs to consider teratogenicity. In addition, drug resistance can impact response.
In addition, the newborn should be evaluated for congenital malaria.
