Management of severe

anemia in labor

SHEKHAR MOHBE
ROLL NO. – 118
BATCH- 2019
 ANEMIA
A condition in which the blood doesn’t have enough healthy red blood cells.

CLASSIFICATION:
• Deficiency anemia :
1. Iron deficieny
2. Folic acid deficiency
3. Vitamin B12 deficiency
4. Protein deficiency
• Hemorrhagic
1. Acute: Following bleeding in early months or APH
2. Chronic: Hookworm infestation, bleeding piles, etc.
• Hereditary
1. Thalassemias
2. Sickle cell hemoglobinopathies
3. Other hemoglobinopathies
4. Hereditary haemolytic anemias (RBC membrane defects)

• Bone marrow insufficiency

• Anemia of infection
• Chronic disease
• Hematological malignancy
• Hemolytic

The fall in the haemoglobin concentration during pregnancy is due to combined effect of
hemodilution and negative iron balance.

During pregnancy
The factors that lead to the development of anemia during pregnancy are:
• Increased demand of iron
• Diminished intake of iron
• Diminished absorption
• Disturbed metabolism
• Pregnant health status
• Excess demand
 Iron deficiency anemia
Gradings of Anemia Based on Hemoglobin Levels (WHO 2011)
• Normal level in pregnancy >= 11gm/dL

Anemia
• Mild: 10.0 to 10.9 gm/dL
• Moderate: 7-9.9 gm/dL
• Severe: <7 gm/dL
• Very severe: <4 gm/dL
Complications of anemia in pregnancy
During pregnancy:
• Pre-eclampsia
• Intercurrent infection
• Heart failure
• Preterm labor

During labor:
• Uterine inertia
• Postpartum haemorrhage is a real threat
• Cardiac failure
• Shock

Puerperium
• Puerperal sepsis
• Subinovoulution
• Poor lactation
• Puerperal venous thrombosis
• Pulmonary embolism
• Poor wound healing
Treatment
General treatment:
• Diet
• To improve the appetite and facilitate digestion
• Effective therapy to cure

Iron therapy:
• Oral therapy

Preparations and the iron content

Iron salt Amount Ferrous iron (mg)
(mg)
Ferrous fumarate 200 65
Ferrous gluconate 300 35
Ferrous sulphate 300 60
Ferrous sulphate (dried) 200 65
Parenteral therapy:
• Intravenous route
1. Iron sucrose 20 mg elemental iron/mL
- 100 mg per dose, 1 dose daily for 10 days
2. Sodium ferric gluconate

• Intramuscular therapy
The compounds used (with elemental iron/mL) are –
1. Iron sucrose (20 mg/mL)
2. Sodium ferric gluconate complex 12.5 mg elemental iron/ mL.
3. Iron dextran (Imferon) (50 mg/mL).

Blood transfusion:
The indication are:
1. To correct anemia due to blood loss and to combat postpartum hemorrage.
2. Patient with severe anemia- seen in later month of pregnancy beyond 36 week.
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