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:
- Decreased intake/deficiency anaemia isolated or combined :
- Folic acid deficiency
- Vitamin B12
- Increased loss/haemorrhagic:
- Acute: Following bleeding in the early month or APH
- Chronic: Hookworm infestation, bleeding PUD, bleeding haemorrhoids.
- Sickle cell anaemia/hemoglobinopathies
- Hereditary hemolytic anaemia
- Other hemoglobinopathies.
- Bone marrow insufficiency: Hypolasiaorb aplasia due to radiation drugs (Indomethacin aspirin etc).
- Anaemia due to infection: Malaria
- Anaemia due to chronic disease: Chronic renal
Management of a case of anaemia:
- Clinical features of both iron and folate deficiency
- Lassitude and a feeling of exhaustion
- Pallor of varying degree
- Evidence of glossitis and stomatitis
- Oedema (may be due to pre-eclampsia or protein)
Investigation of anaemia:
A. Investigation of iron deficiency anaemia:
- Blood picture : Reduced Hb%, MCV, MCH and MCHC
- 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:
- TC, DC, ESR
- Blood grouping
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:-
- Prophylactic antibiotic to prevent infection
- Iron therapy should be continued for at least 3 months to replenish iron store
Complications of anaemia in pregnancy:
A. During pregnancy:
- Heart failure
- Pre-term labour.
B. During puerperium: There is an increased chance of:
- Puerperal sepsis
- Failing lactation
- Increased incidence of LBW.