Anemia in Pregnancy

most common hematological disorder in pregnancy,(others Rh isoimmunization and blood

coagulation disorder).

Classification

● Physiological anemia of pregnancy

● Pathological

1. Deficiency Anemia(Isolated or combine)

● Iron deficiency
● Folic Acid deficiency
● Vitamin B12 deficiency
● Protein deficiency
2. Hemorrhagic
● Acute: Following bleeding in early months or APH
● Chronic: Hookworm infestation,bleeding piles,etc.
3. Hereditary
● Thalassemias
● Sickle cell hemoglobinopathies
● Hereditary hemolytic anemias(RBC membrane defects,
spherocytosis)
4. Bone marrow insufficiency - hypoplasia or aplasia due to radiation,drugs
(aspirin,indomethacin)
5. Anemia of infection (malaria,tuberculosis,kala-azar)
6. Chronic disease (renal or neoplasm)
7. Hematologic malignancy (leukemias,lymphomas).
8. Hemolytic - SLE,HELLP syndrome,autoimmune hemolysis,drug induced
G6PD deficiency.

Concept of Physiological Anemia

Maternal plasma volume increases by about 40-50%. RBC volume increases by 20%.There is a
relative fall in the level of hemoglobin and hematocrit during pregnancy. All these values return
to normal by 6 weeks postpartum.

Thus, the fall in the hemoglobin concentration during pregnancy is due to the combined effect
of hemodilution and negative iron balance.

Criteria of Physiological Anemia - The lower limit of physiological anemia during the
second half of pregnancy should fulfil the following hematological values.
 1. HB-10 g%
2. RBC-3.2 million/mm³
3. PCV-32% and
4. Peripheral smear showing normal morphology of the RBC with central pallor

Causes of Increases Prevalence of Anemia in Tropics

Before Pregnancy
● Faulty dietetic habit
● Faulty absorption mechanism
● Iron loss
1. More iron is lost through sweat
2. Repeated pregnancies at short intervals
3. Excessive blood loss during menstruation
4. Hookworm infestation
5. Chronic malaria
6. Bleeding piles and dysentery

During pregnancy
● Increases demands of iron
● Diminished intake of iron
● Diminished absorption
● Disturbed metabolism
● Pregnant health status
● Excess Demand
1. Multiple pregnancy
2. Women with rapidly recurring pregnancy
3. Women with heavy menstrual bleeding(HMB)
4. Twin pregnancy when iron demand is high
5. Anemia due to underlying disease(UTI)

Iron deficiency Anemia

Clinical Features
● Symptoms
1. Lassitude and fatigue or weakness may be the earliest manifestations.
2. The other feature are anorexia and indigestion; palpitation caused by ectopic
beats, dyspnea, giddiness and swelling of legs
● On Examination - Pallor

Investigations
 ● Degree of anemia
1. Hb
2. RBC count
3. PCV
● Type of anemia
1. Peripheral blood smear
2. Hematological indices
● Cause of anemia
1. Stool examination
2. Urine examination

Complications of Anemia in Pregnancy

During Pregnancy
1. Pre-eclampsia
2. Intercurrent infection
3. Heart Failure
4. Pretern labor

During Labor
1. Uterine inertia
2. Postpartum hemorrhage
3. Cardiac failure
4. Shock

Puerperium
1. Sepsis
2. Subinvolution
3. Poor lactation
4. Puerperal venous thrombosis
5. Pulmonary embolism
6. Poor wound healing

Effects on baby
1. Low birth weight
2. Intrauterine death
3. Anemia in infancy

Treatment
Prophylactic
● Supplementary iron therapy - Daily administration of 200 mg of ferrous
sulphate(containing 60 mg of elemental iron) along with 1mg folic acid is a quite
effective prophylactic procedure
● Dietary prescription
● Adequate treatment - Eradicate hookworm infestation, dysentery, malaria, bleeding piles
and urinary tract infection.

Curative

● Hospitalization
1. Hemoglobin level 9 g/100ml or less
2. Associated obstetrical-medical complication

● General Treatment
1. Diet
2. To improve the appetite and facilitate digestion
3. To eradicate septic focus
4. Effective therapy to cure

● Choice of therapy depends on

1. Severity of anemia
2. Duration of pregnancy
3. Associated complicating factors

● Iron therapy
● Oral Therapy - Ferrous Fumarate,Ferrous gluconate, Ferrous Sulphate
○ Drawbacks of oral iron therapy
■ Intolerance
■ Unpredictable absorption rate

● Parental therapy

○ Intravenous route (Iron sucrose , Sodium ferric gluconate complex,

parenteral iron therapy)
■ Repeated injections
■ Total dose infusion (TDI)

○ Intramuscular route (Iron sucrose , Sodium ferric gluconate complex,

Iron dextran)
 ● Indications of parenteral therapy
1. Contraindications of oral therapy
2. Patient is not cooperative to take oral iron
3. Cases seen for the first time during the last 8-10 weeks with severe anemia

Management during labor

First Stage
● Patient should be in bed
● Oxygen therapy with nasal cannula
● Strict asepsis

Second Stage
● Injection oxytocin 10 IU should be given soon following delivery of baby

Third Stage
● Significant amounts of blood loss should be replenished by fresh packed cell transfusion
after taking the usual precautions.