AMEMIA IN PREGNANCY

Prepared By:
Ms. Mandeep Kaur
Associate Professor, OBG
Nightingale College of Nursing, Narangwal,
Ludhiana (Pb).
 Definition

*Anemia - insufficient Hb to carry out O2

requirement to the tissues.
*WHO definition : Hb conc. < 11 gm %
*CDC definition : Hb conc. < 11gm % in 1st and
3rd trimesters and < 10.5 gm% in 2nd trimester
 ANAEMIA IN PREGNANCY

Definition: By WHO
Hb. < 11 gm /dl
Mild anaemia -------- 9 -10.9
gm /dl Moderate anaemia--- 7-8.9
gm /dl Sever anaemia--------<
7gm /dl Very sever anaemia--
< 4gm/dl
 Incidence of Anemia

*Globally, is about 30 %
*In developing countries & India, incidence is
around 40 – 90%.
 Clinical Features

Conjunctiva Pallor of skin

Pallor

Edema

Tachycardi Platynychia
a
Koilonychia
Glossitis
Stomatitis
 Irritability
Lack of
Concentration

Fatigu
Infection e

Weakness
Palpitation

Dizziness
Normal hemoglobin by gestational age in pregnant
women taking iron supplement

12 wks 12.2 [11.0-13.4]

24wks 11.6 [10.6-12.8]

40 wks 12.6 [11.2-13.6]

 Iron Requirement During
Pregnancy
32 to 40
weeks
20 to 32
weeks 6.8 mg /
Early day
Pregnancy 5.5 mg /
day
2.5 mg /
day

TOTAL
800 – 1000 mg
Depleted iron stores –
dietary lack
chronic renal failure
worm infestation
Chronic infections: ( like malaria)
Repeated pregnancies :
- with interval < 1
year
- blood loss at time of
delivery
- multiple pregnancy.
EFFECTS OF ANAEMA IN
PREGNANCY
 INVESTIGATIONS

 CBC
 MCV, MCH, MCHC
 TIBC
 Serum Iron
 Serum Ferritin
 Bone marrow examination
 Urine examination
 Stool examination
 Serum protein
 SPECIAL TESTS

 Serum Folate
 RBC folate
 Serum Vit B12
 Serum Bilirubin
 Coombs test
 HB electrophoresis
 NESTROF test
 Red cell osmotic fragility
MANAGEMENT
 ta ry nt
Die eme
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 Treatment

• Prophylactic:
– Avoidance of frequent child births
– Supplementary iron therapy
– Dietary prescription
– Adequate treatment
– Early detection of falling Hb level is to be made
• Curative:
– Hospitalisation
– General treatment:
• Diet
• To improve appetite and facilitate digestion
• To eradicate even minimal septic focus
• Effective therapy to cure the disease
 Specific therpay
• Depends on:
– Severity
– Duration of pregnancy
– Assoc complicating factors
 Iron therapy
• Oral route:
– Drawbacks:
• Intolerance
• Unpredictable absorption rate
– Response:
• Sense of well being
• Increased appetite
• Improved outlook of the patient
• Rise in Hb level
– Rate of improvement – within 3 weeks
– Failure:
• Improper typing of anemia
• Defective absorption
• Pt fails to take iron
• Concurrent blood loss
– Contraindication:
• Intolerance
• Severe anemia in advanced pregnancy
• Parenteral therapy:
– Intravenous and Intramuscular
– Indications:
• Contraindications of oral therapy
• Pt not co-operative to take oral iron
• Cases seen for the first time during the last 8 – 10
weeks in severe anemia
• Intravenous route:
– Total dose diffusion: deficit of iron is calculated and the
total amount of iron required is administered by a
single sitting intravenous infusion
– Advantages:
• Eliminates repeated and painful intramuscular
injections
• Treatment completed in a day
• Less costly
• Intramuscular therapy:
– Total dose to be administered is calculated
– After an initial dose of 1ml, the injections are given
daily or on alternate days in doses of 2ml
intramuscularly.
– Drawbacks:
• Painful
• Chance of abscess
• Reactions
• Blood transfusion:
– Limited. But indications are:
• PPH
• Severe anaemia in later months of pregnancy
• Assoc infection.
– Quality and quantity: fresh. Only packed cell. 80 –
100 ml at a time
– Advantages:
• Increased oxygen carrying capacity of the
blood
• Hb may be utilised for the formation of new red
cells.
• Stimulated erythropoiesis
• Improvement expected after 3 days
THANK YOU