ANEMIA IN PREGNANCY

Nandini Vijayakumar

MENTORS: Dr. Mangala

Dr. Abhilash
 Patient Particulars
• Name: Mrs. XYZ
• Age: 29 yrs
• Blood group: B +ve
• Address: RT Nagar
• Occupation: Metro driver
• Education status: Higher secondary
• Husband’s name: Mr. XXS Age:32 years
• LMP: 30.11.2019 EDD: 7.9.2020
• Parity index: Primigravida
• Gestational Age: 30 weeks
• Socio economic state: Lower middle class
• Date of examination : 3.3.2020
 Chief Complaints
• Easy fatigability since one month
• Loss of appetite
 History of presenting illness
• Patient with history of 30 weeks amenorrhea, presents with
complaints of easy fatigability and generalized weakness.
Previously, the patient was able to manage work and
household chores but in the past month she gets tired with
minimal work. On walking about 100m, patient complains of
fatigue and slight giddiness that is relived on rest.
• Patient also complains of difficulty in breathing on exertion,
since one week. Insidious in onset and gradually progressive
which aggravates on climbing stairs and relives on taking rest.
• Breathlessness not associated with wheezing, coughing, palpitation
and chest pain.
• No history of pedal edema
• No history of elevated bp
• No history of bleeding or leaking per vagina
• No history of yellow discoloration of urine, skin or eyes
• No history of reduced urinary output
• No history of fever with chills and rigor, burning micturition
• No history of passage of worms in stool
• No history of trauma, hemoptysis, hematemesis, melena
• No history of hematuria, facial puffiness
• No history of bleeding disorders
• No history of headache, blurring vision
• No history of evening rise in temperature or contact with
tuberculosis
• Not a known diabetic or hypertensive
 History of present pregnancy
• 1st TRIMESTER:
• Pregnancy detected at home with urine pregnancy test after one
month of her missed period.
• Bp: 110/70 mmHg
• History of spontaneous conception
• Folic acid tablet taken
• NT Scan done after 12 weeks ( normal)
• h/o increased frequency of micturition
• No history of fever with rashes, excessive vomiting
• No history of spotting or bleeding PV
• No history of pain abdomen
• No exposure of radiation, drug intake
• No history of craving for abnormal food (pica)
• 2ND TRIMESTER:
• She felt quickening at 5 months
• Td vaccine administered
• Anomaly Scan done at 5 months (NAD)
• Prophylactic iron tablet not taken regularly.
• No history of pedal edema, blurring of vision or
headache
• No history of pain abdomen, leaking or bleeding
per vagina
• No history of polyuria, polydipsia, polyphagia
 Menstrual history
• Menarche:13 years
• Past cycles: regular cycles of 28 days, flow for
3-4 days
• Associated with dysmenorrhea
• No history of passage of clots
• LMP: 30.11.2019
• EDD: 7.9.2020
MARITAL HISTORY
• Married at the age of 28year
• Married life of 8 months
• Non consanguineous marriage
PAST HISTORY
• Known asthmatic (not using inhaler now)
• No history of blood transfusion
• No history of recent surgeries
• Not a known case of hypertension, Diabetes
mellitus, TB, epilepsy
• No history of infection or malignancy in the past
FAMILY HISTORY
• Mother is a known hypertensive
• No history of repeated blood transfusion or
bleeding disorder
• No history of children with chromosomal
anomaly or birth defects
• No history of twining in the family
• PERSONAL HISTORY:
• Diet : mixed
• Appetite: reduced in the last month
• Sleep: adequate
• Bowel and bladder: normal and regular
• No history of substance abuse
• No history of any drug allergy
• No history of use of contraception

• DIET HISTORY:
• Breakfast: 3 idlis with chutney
• Lunch : dal and rice
• Evening snack: tea and biscuits
• Dinner: roti and mixed vegetable curry
 Summary of history
• 29 year old primigravida with history of 7
months amenorrhea has complaints of easy
fatigability and loss of appetite. Patient
complains of breathlessness on exertion and
increased frequency of micturition. Patient
has not been compliant in taking antenatal
oral iron supplements.
• Symptoms suggestive of anemia in pregnancy.
 General physical examination
• Patient is conscious, cooperative and well oriented to
time, place and person.
• Patient is moderately built and nourished

• VITALS:
• Pulse: 90/min ; regular rhythm, good volume. No radio-
radial or radio-femoral delay. All peripheral pulses are
felt.
• Respiration: 20 breaths/min
• BP:110/70 mmHg, right arm supine position
• Patient is afebrile
• Pallor present
• No icterus, clubbing, cyanosis, lymphadenopathy, edema
• Height : 5.5 ft
• Weight: 62.2 kgs
•

• HEAD TO TOE EXAMINATION:

• Pallor seen in the lower palpebral conjunctiva
• There is no angular stomatitis, glossitis,Cheilosis
• Nails: no platonychia, no koilonychia
• No pedal edema
• Thyroid appears normal
• Spine appears to be normal

• BREAST EXAMINATION:
• Normal changes of pregnancy seen
• Nipple show no retraction or inversion
 Obstetric Examination
• ABDOMEN EXAMINATION:
• Inspection:
• Shape of abdomen is globular, longitudinally distended
• Corresponding quadrants moves equally with respiration
• Umbilicus is central and everted. Flanks are not filled
• Linea nigra and stria gravidum present
• No scar marks, sinus or dilated veins
• Hernia orifices are intact

• Palpation:
• No local rise of temperature or tenderness
• Abdominal girth is 76cms( at the level of the umbilicus)
• Symphysio-fundal height is 29 cm, corresponds to gestational age
• Uterus is relaxed, palpable and soft.
• Leopold maneuvers:
• Fundal grip: soft, broad and irregular mass. Suggestive
of breech
• Lateral grip:
• Knob like structures on the right side, suggestive of
limb buds
• Uniform resistance on left side, suggestive of spine
• 1st pelvic grip: smooth, hard, single ballotable mass
suggestive of head
• 2nd pelvic grip: approximation of fingers, suggestive
that head is not engaged
• Auscultation:
• Fetal heart sound: 142 beats/ mins
• Regular at left spino-umbilical line 4cm from
umbilicus
 SYSTEMIC EXAMINATON
• CVS: S1 and s2 heard, no murmurs
• RS: Normal vesicular breath sounds heard
• no added sound
• CNS: no focal neurologic deficit
• No hepato-splenomegaly.
 Investigation
• URINE:
• Albumin : absent
• Sugar : absent
• Pus cells : 1-2
• BLOOD:
• Hb % : 7.4gm%
• Grouping : B +ve
• VDRL : non reactive
• HIV(after counseling) : negative
• HBSAG : non reactive
• RBS : 126mg/dl
 Diagnosis
• 29 year old female with obstetric score G1,
with history of 30 weeks gestation and a single
live foetus is cephalic presentation shows
features suggestive of anemia not in failure.