Anemia in Pregnancy

Dr. Inzama Wilfred

 Outline
• Definition
• Classification of anaemia
• Diagnosis
• Management
 Definition
 Anemia; refers to hemoglobin concentration of
less than 10.5 g/dL
 During pregnancy, plasma volume increases 25–
60%.
 The red blood cell (RBC) mass increases by 10–
20%.
 The disproportionate increase in plasma volume
compared with RBC mass results in hemodilution
and also know physiological anaemia.
 Classification of anemia

 Excessive destruction of RBCs

 Blood loss
 Inadequate production of RBCs
 Excessive destruction of RBCs

 Sickle cell anemia

 Thalassemia
 Glucose-6-phosphate dehydrogenase (G6PD)
deficiency
 Hereditary spherocytosis.
 Infections e.g. malaria
 Blood loss

 Inflammatory bowel disease (IBD) e.g

(hookworm infection).
 Anemia sometimes results from heavy
menstrual periods in teen girls and women.
 History of bleeding in early pregnancy
 History of postpartum hemorrhage with short
pregnancy interval
 Inadequate production of RBCs

 Aplastic anemia e.g. viral infection

(parvoviruses), radiation, or medications (such
as antibiotics, anti-seizure drugs, or cancer
treatments).
 Poor dietary iron intake
 Diagnosis
 History
 Physical examination
 Laboratory evaluation
 History and examination
 Irritability
 Fatigue
 Dizziness, lightheadedness, rapid heart beat,
headache and malaise
 In severe cases, pallor of mucous membrane,
glossitis, stomatitis, koilonychia, splenomegaly,
shortness of breath, gallop rhythm
 Laboratory Evaluation
 CBC; may indicate that there are fewer RBCs than normal.
 Blood smear examination; determine the cause of anemia
 Iron tests; These include total serum iron and ferritin tests,
which can help to determine whether anemia is due to iron
deficiency.
 Hemoglobin electrophoresis; to diagnose sickle cell anemia
thalassemias
 Bone marrow aspiration and biopsy; to diagnose aplastic
anemia
 Reticulocyte count; A measure of young RBCs, this helps to
determine if RBC production is at normal levels.
 Management
 Management dependents on degree of
anemia
 Mild 9-10.9gm/dl
 Moderate 7-8.9gm/dl
 Severe 4-6.9gm/dl
 Very severe anemia <4gm
 Mild to moderate Anemia

 120mg elemental iron daily (equivalent to 600mg FeSO4) - given in

two separate doses
 0.4mg folic acid supplementation
 until her haemoglobin concentration rises to normal.
 She can then switch to 30-60mg of elemental iron plus 0.4mg of folic
acid, daily.
 Iron dextrant
 Good nutrition; food with high content of iron e.g. liver, cereals,
vegetables etc
 Sleep under insecticide treated mosquito nets
 Severe to very severe Anemia
 Severe anemia has to be aggressively treated before the woman
goes into labour
 During labour a patient may go into cardiac failure.
General Principles;
 Treat the cause if determined.
 Obtain blood for grouping and Cross-matching, then give blood
transfusion (packed cells); transfuse SLOWLY one unit over 6 hours If
whole blood, administer with 1mg/kg of frusemide slowly for over
four hours
 Follow up the patient until Hb reaches 11 g/dl
Prevention of anemia in pregnancy
 30-60mg of elemental iron (equivalent to 150-300mg FeSO4)
 0.4mg of folic acid daily.
 Mebendazole 500mg
 Eat food high in iron contents e.g. liver, vegetables, cereals
 Fansidar; at least 4 doses during pregnancy
 Sleep under insecticide treated mosquito nets
 Treat for malaria
 In labor
 Nurse patient in a propped-up position
 Obtain blood for Hb, grouping and cross-matching.
 Note: Do not give blood transfusion while in labour.
 Insert an indwelling urethral catheter
 Administer IV frusemide 80 mg stat
 Give oxygen 4-6 liters per minute and keep the patient in
well ventilated room
 Conduct delivery while the patient is in semi-sitting position
 Encourage the woman to refrain from bearing down with
contractions
 Assist second stage by vacuum extraction.
 In labor
 Do active management of third stage of labour by:
 Give intramuscular oxytocin 10 i.u within one minute of birth of the baby.
 Do not administer Ergometrine or Misoprostol
 Applying controlled cord traction while applying counter traction on the uterus.
 Uterine massage following delivery of placenta and palpation
 Massage of uterus every 15 minutes for 2 hours.
 Give another dose of intravenous Frusemide 80 mg.
 Monitor vital signs (blood pressure, pulse rate, temperature and respiratory rate) every half
an hour
– Monitor input/output.
– Monitor closely for signs of heart failure during post-partum period.
– Investigate and treat the underlying cause of anaemia.
 Give iron and folic acid supplementation for treatment of anaemia
 Re- assess the condition monthly until the Hb reaches normal level 11mg/dl.
 Switch to the standard antenatal dose to prevent recurrence of anaemia, i.e. 30-60mg of
elemental iron plus 0.4mg of folic acid, daily.
 Provide health education for prevention of anaemia.
Complications of anemia in pregnancy

 ANC; abortions, IUGR, preterm labor, low

weight babies
 Intra-partum; maternal exhaustion, delay in
second stage of labour
 Postpartum period; Postpartum hemorrhage,
infections