Treatment of Cholera in Pregnancy — Second or Third Trimester
Cholera occurring during the second or third trimester of pregnancy is a high-priority clinical situation. Fluid loss poses compounded risks to both mother and fetus, and management must account for pregnancy as a coexisting condition alongside the degree of dehydration present.
Clinical Scenario
Pregnant patients in the second or third trimester with cholera are assessed through a dedicated evaluation framework. Pregnancy is recognised as a coexisting condition that directly shapes how rehydration and treatment are approached, regardless of the degree of dehydration.
Treatment Approach
Management is stratified by haemodynamic status and hydration state. Rehydration is central — the route chosen (oral or intravenous) depends on the patient's blood pressure and ability to tolerate fluids. This is combined with a single-dose antibiotic regimen. The complete protocol specifies the assessment criteria, fluid strategy, and antibiotic selection for this population.
Clinical Goals
- Systolic blood pressure maintained above 90 mmHg
- No signs of severe dehydration
References
- The second and third trimester initial evaluation is detailed in Table 6.
- Patients with coexisting conditions (including pregnancy) or comorbidities (such as Severe Acute Malnutrition (SAM), and HIV), regardless of the degree of dehydration
- Oral rehydration: 75 ml/kg ORS over 4 hours
- At least 250 ml of ORS after each stool
- If the patient has difficulty drinking ORS, pass rapidly to IV rehydration (75 ml/kg of RL).
- At least 250 ml of ORS after each stool under observation for 4-6 hours
- Single-dose antibiotic therapy