Anaemia in Pregnancy

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ANAEMIA IN PREGNANCY

Introduction of anaemia:

  • Anaemia is a major killer in India
  • Statistics reveal that every second Indian woman is anaemic
  • One in every five maternal deaths is directly due to anaemia
  • Anaemia affects both adults and children of both sexes although. Pregnant women and adolescent girls are most susceptible and most affected by this

 

Definition of anaemia:

Anaemia is a clinical condition when the haemoglobin level in the blood is below the lower extreme of the normal for the age and sex of the individual.

 

Definition of anaemia in pregnancy :

According to the standard laid down by WHO. When the haemoglobin concentration in peripheral blood is < 11gm/ dl.

Causes/classification of anaemia in pregnancy:

A. Physiological anaemia of

B. Pathological anaemia of pregnancy:

  1. Decreased intake/deficiency anaemia isolated or combined :
    • Iron
    • Folic acid deficiency
    • Vitamin B12
    • Protein
  2. Increased loss/haemorrhagic:
    • Acute: Following bleeding in the early month or APH
    • Chronic: Hookworm infestation, bleeding PUD, bleeding haemorrhoids.
  3. Hereditary:
     
  • Sickle cell anaemia/hemoglobinopathies
  • Hereditary hemolytic anaemia
  • Other hemoglobinopathies.
  1. Bone marrow insufficiency: Hypolasiaorb aplasia due to radiation drugs (Indomethacin aspirin etc).
  2. Anaemia due to infection: Malaria
  3. Anaemia due to chronic disease: Chronic renal

 

Management of a case of anaemia:

Severe anaemia:

  • Clinical features of both iron and folate deficiency
  • Symptoms:
    • Lassitude and a feeling of exhaustion
    • Weakness
    • Palpitation
    • Anorexia
    • Indigestion

Signs/examination findings:

  • Pallor of varying degree
  • Evidence of glossitis and stomatitis
  • Koilonychia
  • Oedema (may be due to pre-eclampsia or protein)

 

Investigation of anaemia:

A. Investigation of iron deficiency anaemia:

  1. Blood picture : Reduced Hb%, MCV, MCH and MCHC
  2. Biochemical findings: Serum iron, ferritin, and % saturation and serum total iron binding

B. Investigation of folate deficiency anaemia

Blood picture: Hb% is reduced but MCV is increased (macrocyte).

Bone marrow examination: Megaloblasts are found.

Special test: serum, and red cell

C. Investigation for other medical and obstetrical statuses:

  1. TC, DC, ESR
  2. ECG
  3. RBS
  4. Blood grouping
  5. Echocardiography
  6. Ultrasonography

 

Treatment of Iron deficiency anaemia:

A. General treatment:

  • Diet: A realistic balanced diet rich in protein

B. Specific treatment:

  • Oral Iron therapy: Ferroussulfate 200mg - 1gm/day in tab or cap form. A maintenance dose of 200-400 mg/day should be continued for at least 100 days to replenish the iron store.

C. Management during puerperium:-

  1. Prophylactic antibiotic to prevent infection
  2. Iron therapy should be continued for at least 3 months to replenish iron store

 

Complications of anaemia in pregnancy:

Maternal complications:

A. During pregnancy:

  1. Pre-eclampsia
  2. Heart failure
  3. Pre-term labour.

B. During puerperium: There is an increased chance of:

  1. Puerperal sepsis
  2. Subinvolution
  3. Failing lactation

 

Fetal complication:

  • Increased incidence of LBW.
  • IUGR.
  • IUD.