A STUDY TO ASSESS THE LEVEL OF ANAEMIA AT FIRST BOOKING VISIT AMONG PRIMI & MULTIGRAVIDA MOTHERS AT SELECTED MATERNITY

CENTRE, SALEM
By Mrs .K.Thilagavathi,M.Sc(N)., Lecturer, Shanmuga college of nursing,salem

INTRODUCTION
 Anemia associated with pregnancy is major public health problem all over the world.  According to WHO estimation55-60% of pregnant women in developing countries and 18% of women in developed countries suffer from anemia.  In India, the incidence of anemia among expectant mothers is alarmingly is as high as 60-70%. contd ..

Maternal anemia was found to be significantly associated with more frequent preterm birth and increased low birth weight new born. It contributes directly to 20% of maternal deaths and is a contributory factor in another 20% of maternal deaths due to obstetrical hemorrhage, obstructed labour, sepsis and other causes.

OBJECTIVES
1. To assess and compare the level of anemia at first booking visit between primigravida & Multigravida mothers.

2. To find association on level of

anemia among primigravida mothers with selected Sociodemographic variables -age, educational status and family monthly income. 3. To find association on level of anemia among Multigravida mothers with selected Sociodemographic variables namely age,

METHODOLOGY
 Research Design: Descriptive comparative design  Setting: Ammapet Maternity Corporation Centre, Salem.  Population: Primi and Multi gravida mothers having regular antenatal checkup  Sample: Primi and Multi gravida mothers having regular antenatal checkup in Ammapet Corporation Centre, Salem.

Sampling criteria
Inclusion criteria: 1. Antenatal mothers who had their Hemoglobin estimation done from PPTCT clinic within 12-16 weeks of gestation 2. Mothers who are willing to participate Exclusion criteria: 1. Mothers who have a history of bleeding disorders 2. Mothers those who had recent blood transfusion 3.Mothers those who had previous abortion

Sampling Technique:
NonProbability convenient sampling technique Sample size: 60 in each group Tools; Tool-I: Sociodemographic Variables of the samples.

Tool-II:Hemoglobin Estimation at first booking visit

This was noted from the record of antenantal mother done from PPTCT Clinic.  Interpretation of anemic status based on Hemoglobin value was made from WHO criteria as follows; 

Severity of anemia

Cut off level of Hb

Normal

11 gm%

Eclampsia
Derived from Greek word, Eklampnis- shining forth/like a flash of lightening It may occur quiet abruptly with or without warning manifestation It is a life-threatening condition for both a mother and her fetus. During a seizure, the oxygen supply to the fetus is drastically reduced.

INCIDENCE

1/500 to 1/30(India)

75% in Primigravida

Five times more common in twin pregnancy

PRE DISPOSING FACTORS

Genetic predisposition Immunlogical Preexisting vascluar and renal disease Hyperplacentosis multiple pregnancy diabetes Molar pregnancy Hydrops fetalis

ETIOPATHOGENESIS
IMBALANCE IN PROSTAGLANDIN RATIO PLACENTAL VASOCONSTRICTION REDUCED PERFUSION RELEASE OF RENIN
ANGIOTENSIN I

THROMBOPLASTIN GENERALIZED VASOCONSTRICTION

RENAL GLOMERULAI AFFECTED

ANGIOTENSIN II

HYPERTENSION PROTEINURIA
HEADACHE VISUAL DISTURBANCES

ADRENAL HORMONES ALDOSTERONE SODIUM REABSORPTION

SEIZURES

EDEMA

OLIGURIA

ONSET OF FITS Antepartum(50%) Intrapartum(30%) Postpartum(20%)

SIGNS OF IMPENDING ECLAMPSIA A sharp rise in blood pressure Diminished urinary output Increase proteinuria Frontal headache Drowsiness/confusion Visual disturbances Epigastric pain Nausea and vomiting

STAGES OF ECLAMPTIC FIT

Premonitory stage Tonic stage Clonic stage Stage of coma

EFFECTS OF ECLAMPSIA
Maternal
          Injuries tongue bite Cerebral oedema,haemorrhage Eyes-disturbed vision Cardiac acute left ventricular failure pulmonary oedema,pneumonia,adult respiratory syndrome,embolism Renal renal failure Hepatic - necrosis ,subcapsular haematoma ( HELLP) Haematological-thrombocytopenia,DIC Hyperpyrexia Postpartum-shock,sepsis,psychosis

Fetal Effects
o perinatal mortality rate

o o o o o

(30-50%) prematurity intrauterine growth retardation intrauterine asphyxia effects of drugs obstetrical trauma

DIAGNOSITIC MEASURES oUrine analysis oBlood values oDoppler velocimetry oSerial ultra sound and Non-stress test

MANAGEMENT
Principles 1.Resuscutation 2.Oxygen administration 3.Arrest convulsions 4.Ventilatory support 5.Haemodynamic stabilization 6.Organise investigations 7.Deliver by 6-8 hours 8.Intensive postpartum care

1. GENERAL MANAGEMENT
Admit in dark room to avoid noxious stumuli Collect detailed history Carryout physical examination Catheterization Monitor vital signs q1/2 hourly Maintain fluid balance Antibiotic therapy Management during fits Intensive care monitoring to treat complications promptly

2. SPECIFIC MANAGEMENT

Anticonvulsant and sedative regime Lytic cocktail regime Diazepam therapy Phenytoin therapy Antihypertensives and diuretics

MAGNESIUM SULPHATE (PRITCHARD REGIME)

Mechanism of Action reduces motor endplate senstivity to acetylcholine blocks neuronal calcium influx induces cerebral vasodilation,dilates uterine arteries increases production of endothelial prostacylin and inhibit platelet activation Key features 1. act as anticonvulsant,antihypertensive and vasodilator 2. no detrimental effect to fetus 3 .maternal mortality rate of 0.4%

DOSAGE OG MAG.SULPHATE
Loading dose; 4 gm (20% Maganesium sulphate -I.V) 10 gm(50% Maganesium sulphate deep I.M) Maintenance dose; 5gm I.M q4h in alternate buttocks ( for 24 hours) till last seizure attack

NURSES RESPONSIBILITY
 Monitor vital signs q1h  Check urinary albumin q4h  Monitor fetal heart rate q1h  Monitor blood pressure q1h  Report if, urinary output (<30 ml/hour) respiratory rate (<16/minute)  check the deep tenden reflex (pateller reflex) before administering each dose Cont


 monitor serum magnesium level to rule out toxicity Normal level - 1.8-2.5 mEQ/L Therapeutic level - 4-7 mEQ/L Hyporeflexia - 10-12 mEQ/L respiratory distress - >12 mEQ/L cardiac arrest - > 15 mEQ/L  keep the emergency trolley at bedside inculding inj.Calcium Gluconate

OBSTETRIC MANAGEMENT

PREDICTION
1. Presence of diastolic notch in doppler velocimetry 2. Absence of end diastolic frequency 3. Average MAP >90mmofHg 4. Angiotensin infusion test 5. Roll over test

PREVENTION
1. 2. 3. 4. 5. Regular antenatal check-up Antithrombotic agent Calcium supplementation Antioxidants Nutritional supplementation

RECURRENCE RISK

oPreeclampsia -25% oEclampsia -3%

What is new in preeclampsia

The presence of placental growth factor in the urine (journal of lifeline,Feb/march-2005) Stretching Exercises May Protect Against Preeclampsia(HealthDay News -June 6,2008 )

Women who consume a high amount of dietary fiber during early pregnancy have a reduced risk of subsequent preeclampsia (Dr Chunfang Qiu and his colleagues report online July 17,
2008 in the American Journal of Hypertension)

calcium supplements and low-dose aspirin offer a preventive benefit primapaternity plays a larger role than primagravidity as a risk factor for the development of preeclampsia. (emedicine,may7,2005) increased risk of cardiovascular disease in preeclampsia survivors as compared to women with a history of normotensive pregnancy (preeclampsia foundation,2006) Ongoing research on effect of antioxidants supplementation in prevention of preeclampsia (WHO)

CONCLUSION
Eclampsia is a severe hypertensive disorder in pregnancy accounts for high maternal morbidity and mortality To control eclampsia definite line of treatment is termination of pregnancy irrespective of gestational age.