ANEMIA IN PREGNANCY

-DR TANVI VASALLA

•Mrs.x 22 yr old female
•Resident of Nandgaon, vadodra
•Wife of Mr.y shopkeeper by occupation
•Hindu by religion
•Farmer by occupation
•uneducated
•Belongs to low socioeconomic class according to modified kuppuswami scale
•Obstretic score:G4P3L2A1
•LMP -21/8/2021
•EDD-28/5/2022
Chief complains of 8 months amenorrhea with easy fatigability, breathlessness
on exertion and palpitation since 2 months
Swelling over lower limbs since 1 week
HOPI

• Patient was apparently alright then she developed complains of lethargy and
tiredness increasing progressively in intensity and duration.
• followed by inability to continue her normal work activity.
• It was followed by breathlessness on exertion and palpitations.she also
complained of selling over lower limbs since 1 week Which decreased on
rest .
• No h/o syncope / chest pain / pnd
• No h/o generalised swelling/headache/blurring of vision
• No h/o cough with expectoration/hemptysis/evening rise of temperature
• No h/o bleeding pv/leaking pv
• No h/o worm infestations
• No h/o bleeding pr /malena/hemoptysis
• No h/o fever with chills/hematuria//burning micturition
• No h/o yellowish discoloration of skin or sclera
 HISTORY OF PRESENT PREGNANCY
FIRST TRIMESTER
•Spontaneous conception
•Non consanguineous marriage
•LMP -21/8/2021
•EDD-28/5/2022
•NO history of irregular cycles hence sure of date
•Diagnosed at 1.5 months of amenorrhea by UPT
•Booked at government hospital at 2 months of period of gestation
•Advised anc investigations-normal
•Dating scan done: normal
•Advised 1 yellow tablet od not taken regularly

No history of excessive nausea and vomiting , fever or rashes, radiation exposure, drug exposure, bleeding per vaginum,
discharge per vaginum, burning micturition.
SECOND TRIMESTER
Quickening at 3 months of amenorrhea
Perceiving adequate fetal movements
2 doses of TT taken at 4 and 5 th month
Vaccinated for COVID as well
second usg done at 5th months-normal
Lab investigations done-normal
History of irregular intake of red/yellow/white tablets
No history of high BP Recorded
No history of epigastric pain, blurred vision, headache,decreased urine output and swelling of feet.
No history of excessive hunger and thirst, frequency of micturition or recurrent UTI
No history of easy fatiguability, breathlessness, dyspnea on exertion. Palpitation, syncopal attack and chest pain
No history of fever, burning micturition, bleeding per vaginum and leaking per vaginum
THIRD TRIMESTER

• Patient appreciates adequate movements

• No h/o abdominal.bleeding pv , leaking pv
• Usg done during this admission reported that fetal growth did not correspond
to gestation age.
PAST OBSTRETIC HISTORY:
G4P3L2A1

• P1-4 yr female child ftnd at hospital

• P2-induced abortion at 12 weeks
• P3-2 yr male child preterm delivery with history of blood transfusion for
severe anemia. Child was born with vlbw of 1.5 kgs.
MENSTRUAL HISTORY
Age of menarche 14 yrs
LMP 21/8/2021
EDD 28/5/2022
PAST cycles regular 5-6 days / 28-30 days heavy bleeding using 5-6 pads per day
No history of dysmenorrhea or passage of clots
• Past history: not significant
• Family history: history of hypertension in mother 10 years back . Controlled by oral antihypertensives

• Personal history: adequate sleep

• Normal bowel and bladder
• No history of any addiction/alcohol /smoking
• Belongs to middle class
• No drug addiction
• Dietary history:
Mixed diet by 24 hr recall method
Consumes 1500 kcal /day
With 33 gms protein daily
GENERAL EXAMINATION

• Sitting comfortably
• Concious oriented with time, person and place
• poor build/ mal nourished
• General condition poor
• Ht 152 cm
• Bmi-16
• Pre pregnancy weight44 kgs
• Present wt 53kgs
• Hydration adequate
• Afebrile on touch
• PR 84 /min in rt radial artery with good volume normal character no radiofemoral delay
• all peripheral pulses are palpable.
• BP 120/80 mm hg in right arm in supine position repeated after 15 mins similar finding in left arm

• RR 18/min thoracoabdominal
• Jvp not raised
 •Normal hair texture
•Orodental hygiene fair
• pallor present
•Bilateral pedal odema present
•No clubbing no icterus
•Skin –pale
•Nail ridges (+)
•No palpable lymph node
•Spine normal

•Bilateral breast normal

SYSTEMIC EXAMINATION

• Respiratory system: air entry bilateral equal . No added sound

• Cardiovascular system: apex beat in 4th intercostal place in anterior axillary
line S1 S2 normal no murmur heard
• Central nervous system:no sensory /motor deficit, all reflxes are normal
OBSTETRIC EXAMINATION

Inspection:
Uniformly distended
Uterine ovoid in longitudinal axis
All quadrants moving well with respiration
Umblicus central/inverted
Linea nigra stria gravidarum seen
No dilated veins
PALPATION
All the inspected findings are confirmed
Local temperature not raised
Sfh=28 cm AG 80 cm
Uterus measures 30 weeks size
Relaxed
Longitudinal lie
Fetus cephalic presentation
Uterus relaxed non tender
Liquor adequate
AUSCULTATION:
FHS on right spino umblical line regular 142 beats per minute
Per speculum not done
Per vaginum not done
 SUMMARY:

• 22 Yr female with
• obstetric score G4P4L2A1
• history of ANEMIA and blood transfusion in previous pregnancy with preterm birth
• Period of gestation 32 weeks 5 days
• with singleton live fetus in
• longitudinal lie cephalic presentation
• not in labour. With pallor and pedal odema
• With complains of fatigue and breathlessness on exertion and swelling over legs
PROVISIONAL DIAGNOSIS

• 22 yr female G2P1L1 with 32 weeks 5 days with tiredness , palpitations and

breathlessness on exertion with pedal odema with pallor with live singleton
pregnancy in cephalic presentation suggests of anemia.