ANAEMIA IN PREGNANCY

OBJECTIVES
At the end of this session should be able to:
1. Define what is anaemia in pregnancy
2. Classification of anaemia.
3. Risk factors of anaemia in pregnancy.
4. Clnical features ,diagnosis, and treatment.
5. Complications.
I. DEFINITION OF ANAEMIA

 According to WHO Anaemia in

pregnancy is any Hb level <11g/dl
and any Hb < 10.5g/dl in 2nd & 3rd
trimesters
II. SIGNIFINACE OF ANAEMIA IN PREGNANCY

 Associated with maternal and perinatal morbidities

and mortalities

 Anaemia affects

 56% of pregnant women in developing countries

 18% of pregnant women in developed countries

 III. PREDIPOSING FACTORS FOR ANAEMIA IN
PREGNANCY
1. Physiological changes in pregnancy
– Increase in maternal blood volume
– Iron demands increases for the growing fetus and placenta
2. Rapid growth during adolescence leading to increase
needs for iron
3. Regular menstrual blood loss
4. Other factors:
 Poor diet
 Frequent parasitic infections
 Short intervals between pregnancies (less than two years
interval)
IV. CLASSIFICATION OF ANAEMIA

1. Morphological Classification

2. Aetiological Classification

3. Severity Classification
1. SEVERITY CLASSIFICATION

 Mild Anaemia: Hb 9g/dl – 10.9 g/dl

 Moderate Anaemia: Hb 7.1g/dl – 8.9g/dl
 Severe Anaemia: Hb 5g/dl – 7.0 g/dl
 Very Severe Anaemia: Hb less than 5g/dl
2. AETIOLOGICAL CLASSIFICATION

1. Nutritional anaemia

2. Haemolytic anaemia

3. Haemorrhagic anaemia

4. Other types
 Aplastic etc
1.1 NUTRITIONAL ANAEMIA

I. Iron deficiency anaemia

II. Vitamin B12 & Folate deficiency
(Macrocytic [megaloblastic] anaemia
V. GENERAL FEATURES OF SEVERE ANAEMIA

I. SYMPTOMS
 Tiredness/lassititude
 Shortness of breaths,
 Headache,
 Dizeness,
 Palpitations
 Paroxysmal nocturnal dyspneoa
 Oedema
 Pallor of mucous membranes
GENERAL FEATURES OF SEVERE ANAEMIA cont

II. SIGNS
 Pallor
 Signs of heart failure
 Tachycardia (HR > 100/min),
 Dyspneoa
 Elevated jugular venous pressure,
 Tachypneoa,
 Basal crepitations,
 Enlarged and tender liver
VI. COMPLICATIONS OF ANAEMIA IN PREGNANCY

1. Maternal complications
i. Cardiac failure due to myocardial lack of
oxygen
ii. Preterm labour
 COMPLICATIONS OF ANAEMIA IN
PREGNANCY cont

iii. Maternal deaths - contributes up to 26% either direct

or indirect
iv. Iron deficiency anaemia leads to
 Koilonychias, atrophic glossitis,
 COMPLICATIONS OF ANAEMIA IN
PREGNANCY cont

2. Fetal complications
i. IUFD,
ii. Abortion
Due to poor O2 supply to the placental tissues
iii. Premature delivery
iv. Low birth weight
v. Anaemia as a result of depleted iron stores during
infancy
MANAGEMENT OF ANAEMIA IN
PREGNANCY
 The principles of management of anaemia in
pregnancy depend on;
1. Gestational age
2. Degree of anaemia
3. Causes of anaemia
 VII. INVESTIGATIONS

1. Hb levels 5. Full Blood picture

2. Stool analysis: for worm ova,  Hb (11-16 g/dl)
blood cells  WCC =(4-11 x 109/l )
3. Blood slide: Malarial  Platelets = (150-450) x109/l
parasites  MCV = (76-96)fl
4. Urinalysis – Rbc in urine  MCH = (27-32) pg
5. Blood grouping and x match
VIII. TREATMENT: IRON SUPPLEMENTS

1. Oral iron
 Types: Ferrous sulphate, ferrous gluconate, etc
 Ferous salts show only marginal differences between one
another in efficiency of iron absorption.
 Ferric salts are much less absorbed
 Therapeutic responses
 Hb increases by about 0.1 – 0.2 g/dl per day or
over 2 g/dl over 3 – 4 weeks
 Ingredients
 Some oral preparations contains ascorbic acid to
aid absorption
 TREATMENT: IRON SUPPLEMENTS

2. Parenteral iron
 Indications
 Malabsorption, intolerance, noncompliance
 Note: ?? No significant difference in efficiency of
raising HB between parenteral and oral
preparations
 Types: Iron dextran (inferon), Iron sorbitol (ferrastral)
 Blood Transfusion

Indications for BT
1. Very severe anaemia at any GA

2. Severe anaemia with CCF at any GA

3. Severe anaemia (7g/dl) at or near term(GA≥ 36

weeks)
4. Haemorrhagic shock

5. Refractory anaemia

6. Moderate anaemia In need of surgery

Blood Transfusion cont

If BT is indicated
1. Give packed cell volume to minimize circulatory
overload
2. Administer an IV diuretic ½ hour before
transfusion(Give Frusemide 80-120mg IV), or add
diuretic in blood
3. Avoid BT within 12 hours after delivery
4. One unit of blood increases Hb level by 0.5 – 0.6 g/dl
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR

I. General points
1. Precipitate labour is common
 Because fetal size is small
2. Blood loss, general anaethesia and operative
delivery are all poorly tolerated because of the
underlying hypoxia
3. AVOID intravenous infusions in whatever forms.
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR cont

First stage
• Monitor labour in prop up position
1. Administer IV diuretics – frusemide 80mg
2. Give intermittent oxygen if available
3. Insert urethral catheter
Reduce movements during labour
4. Obtain blood for Hb, grouping & cross matching if possible
5. Do not give IV fluids
6. Avoid blood transfusion during labour
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR cont

Second stage
1. Assist 2nd stage of labour with vacuum:
 To prevent excessive pushing
2. Reduce blood loss
 Avoid – Episiotomy
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR cont

Third stage
1. Active management of 3rd stage: To limit postpartum
blood loss
a. Give oxytocin 10 IU im immediately after delivery
of the anterior shoulder
b. Controlled cord traction
c. Squeezing out clots after delivery of placenta
2. Avoid use of ergometrine
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR cont

AFTER DELIVERY
• Physiological Changes
 Autotranfusion as result of;
 Uterine vessels shut down and Closure of the
arteriovenous (AV) shunts at the placental
beds from the 3rd stage of labour.
 Such changes may lead to increased workload →
Cardiac failure
 Critical time - within 12 hours after delivery.
 MANAGEMENT OF SEVERE ANAEMIA IN
LABOUR cont

2. Esentials of management after delivery

 AVOID IV fluids in any forms even Blood
Transfusion within the first 24 hours after
delivery
 Close observation - ensure that no PPH
 Input output charting
 Cont diuretics and catheterization
Management of Severe Anaemia in Puerperium

 Anaemia which is not corrected during pregnancy may

manifest during puerperium. Itmay also be a result of
blood loss during labour. Its’ management is as follows:
o Ensure there is no active bleeding
o Admit the patient
o Transfuse packed cells slowly, 500 ml of blood in four
hours
o Give only 500 ml (one unit) in 24 hours
o Give haematinics for twelve weeks (three months)
postpartum
IX. PREVENTION OF ANAEMIA IN PREGNANCY

Strategies
1. Screening during antenatal clinic visits
2. Iron and folate: supplementation and
fortification.
3. Malarial disease control: presumptive therapy,
ITN.
4. Family planning – child spacing