ANEMIA IN PREGNANCY

Objectives
Define anemia in pregnancy
List down the signs and symptoms of anemia in
pregnancy
Describe the causes for anemia in pregnancy
Describe the management of anemia in pregnancy
Describe the cause, sign & symptoms, management
and prevention of iron deficiency anemia.
Anemia is the reduction in the oxygen carrying
capacity of the blood which may be due to;
A reduced number of red blood cells

A low concentration of haemoglobin or

A combination of both
Incidence
60% of all women aged 15-49yrs

Who definition;
Hb<11g/dl
Usually treat Hb <10.5
Effects of Anemia
Mother
Fatigue
Lowered to infection
Increased risk of PPH
Problems caused by treatment
Life threatening
Cardiac failure
Fetus
Increased risk of intrauterine hypoxia and IUGR
High perinatal morbidity and mortality if maternal
HB is <6g/dl
Prematurity
Intrauterine death
Signs and Symptoms
Pallor of mucus membrane: eye lids, gums.,
fingernails
Dyspnoea/ shortness of breath
Fainting
Fatigue
Tachycardia and palpation
oedma
Screening
Blood values in pregnancy and non pregnancy differ:
Blood values in pregnancy
Red blood count 3.8X10/l
Size of RBC(MCV-mean corpuscular volume )= 77-93 femto meter
Its haemoglobin content(MCH-mean corpuscular haemoglobin )= 26-32 picograms
Hb concentration(MCHC)= 32-36g/dl
PCV= 0.33l/l
Lab assessment for anemia : at booking visit, 28wka, 36wks, facilities not available clinical
evaluation is necessary
Lack of iron in the diet and thalassemia are the most common causes of hypochromic anemia
(low MCHC).
Mean corpuscular hemoglobin concentration (MCHC) The measurement of the average
concentration of hemoglobin in a red blood cell.
Mean corpuscular volume (MCV) A measure of the average volume of a red blood cell.
Mean corpuscular hemoglobin (MCH) A measurement of the average weight of hemoglobin
in a red blood cell
Iron Deficiency Anaemia
95% of anemia
During pregnancy 1400mg iron needed for
Increased number of red blood cells
Fetus and placenta
Replace daily loss
Replace blood loss at delivery
Lactation
Absorption of iron increased in pregnancy, well
nourished women have adequate store of iron
Causes for Anaemia
Reduced intake- inadequate diet
Reduced absorption nausea and vomiting,
diarrhoea
Excess demand twins, frequent pregnancies,
frequent child birth and breast feeding, early
pregnancy, chronic inflammation
Excessive loss. Eg: menorrhagia, bleeding piles,
APH, PPH, hook worm, malaria
Prevention
Identify at risk women by taking good history of
medical, obstetric, and social situation
Explain what anemia is and why it is important to
prevent it
Information and advice, sources of iron Diet- red
meat, fish, chicken, green leafy vegetables, eggs &
fruit. Vit C helps in absorption of iron
Prophylactic iron- give with folic acid. Eg:
Fefol(150mg iron, 500 micrograms of folic acid)
Investigaton
Hb- will show if anemia but does not show cause
Iron DNA produces small red blood cells MCV falls
first, then MCH, PCV, and Hb
Serum ferritin level falls before Hb
Management
Diet: high iron and folic acid
Rest: gentle work & exercise, plenty of rest

Oral iron

120-1280mg in divided doses

Different types of iron

Combined with folic acid

Hb level increases by 1g per 7-10 days

Storage of iron
Take with vitamin C

Avoid tea and coffee at time of taking iron

Side effects
Black stools
Nausea
Epigastric pain
Diarrhoea
Constipation
Parentral iron
Only use if unable to tolerate oral iron
Hb rises at same rate as oral iron
Not for liver or renal disorders
IM iron 1.5mg/kg daily or weekly
Deep IM injections to prevent staining, abscess, fat
necrosis
Blood transfusion
Severe anemia
Packed cells
Raises Hb quickly if delivery soon
Refer to hospital if
Hb does not rise by 2g after 1 month treatment
At 34 wks haemoglobin is less than 7g
Management
Admit to hospital
Take blood for FBC, group and cross match
Give packed cells of blood
May need frusemide
Check Hb after 3 days
In labour
Admit to hosptial
Intravenous infusion
Take blood for group, cross match, and FBC
Give blood
Shorten 2nd stage, assited delivery
Active management of 3rd stage
Watch woman carefully for sings of deterioration in next
24-48hrs
Even a small amount of blood may be too much for an
anemic woman
Repeat Hb in 1 day and then 3 days