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Anaemia in Pregnancy
Anaemia in Pregnancy
Physiological changes in
pregnancy
Healthy
Physiological changes
Blood
volume;
Plasma volume
Red blood mass
Hypervolemia state, modifies the response
to hypotension in the first half of
pregnancy and the blood loss at delivery.
Vaginal delivery;? ml
Caesarean section? ml
Causes
Inadequate
intake of nutrition
Excess blood loss
Abnormal demand
malabsorption
concentration decrease
MCV
MCH
MCHC
All can be calculated from RBC,
Hb,Packed cell volume.
These tests give basic guide to a
diagnosis in pregnancy.
MCV,
Management
Confirm
diagnosis;
history, examination and
investigation
Treatment depends on the degree of
anemeia and ?????
Treatment
Nutrition
Iron
on
Compliance of the woman
Associated GIT symptoms
Availability of medication
Cost
Oral
Iron,
ferrous fumerate, ferrous sulphate
Does depends on level of HB
Supplement folic acid
Give proper instructions
Care if on throxine, calcium,
infusion
1.
2.
3.
4.
1.
2.
3.
4.
5.
A clinical scenario
A
Haemoglobinpathies
Sickle
cell disease
Is the name given to a group of inherited
blood conditions which include:
Sickle cell anaemia,
Sickle cell beta thalasemia,
Haemoglobin SC disease.
The most common and severe is Sickle
cell anaemia
Antenatal care
Diagnosis
Hb
Infection
Anaemia
Heart failure
Painful crises
Embolism/ stroke
Pulmouary hypertension
Renal dysfunction
Retinal disease
Leg ulcers
Choliothesis
Antenatal follow-up
Mother
MSU
Blood pressure
Dip stick
Renal function
Liver function
Complete blood picture
Will they have Iron deficiency anaemia????
Fetal monitoring
USS
What to give
Folate,
because ??
Asprin , how much???
Heparin, what kind??
In pregnancy Avoid
Hypoxia
Acidosis
Infection
Dehydration
Stress
Exercise
Extreme
Teperature
Treatment
Multi-disciplenary
approach
Supportive measures
Rehydration
Analgesics
Blood transfusion, keep Hb S level<40%
Keep Hb A level >60%
Further Readings
Management of sickle cell Disease in
pregnancy.Guideline No 61 July 2011
www.evidence.nhs.uk
www.rcog.org.uk/Guidelines
spontaneous miscarriage is
increased
The incidence of proteinuric
hypertension increased.
The incidence of spontaneous delivery is
increased.
The incidence of small for gestational
age is unchanged.
The presence of sickle cell disease in the
fetus can not be diagnosed.
Thalasemia minor
HbSS
Beta
Thalasmia minor
HbSC
Sickle cell thalasemia
Sickle cell trait