A CASE OF SEVERE

ANAEMIA IN PREGNANCY
Case presented by
ANAND HEGDE
SAMPRITA .PG
2ND YEAR MBBS
 PERSONAL HISTORY
 Name – NEELAVVA
 Age – 24years
 Address – Hosalli , Gadag district
 Occupation – Housewife
 Income – 8333 rupees /month (1Lakh/year )
 Religion – Hindu
 Education status -SSLC
 SE Status – Middle class(According to modified B.G.Prasad classification)

 Husband s name -CHANDRAPPA

 Age -26 years
 Occupation -Farmer
 Date of admission- 1/8/2018
 Date of examination - 4/8/2018

 G3P2L2 comes with 7 months of amenorrhea, Fetal movements are appreciated well
CHIEF COMPLAINTS
Easy fatigability since 1 months
Fever since 8days
Swelling in lower limbs since 4days
HISTORY OF PRESENTING COMPLAINTS:
Patient presents with 7 months of amenorrhea with easy fatigability since 1
months. Previously, the patient was able to do her household work, but for the
past 1 months, she gets tired even with minimal work. On walking about 100 m,
patient complains of fatigability, giddiness, blurring of vision which is relived on
rest. She also feels fatigue after having food .
Patient presents with history of fever since 8 days back for which she went to
govt hospital shiratti for two days but fever didn’t subside so went to private
hospital in annigeri . Fever is sudden in onset , continuous type, not associated
with chills and rigors (milder type),swelling of face ,joint pain occurred during
fever.
Patient also complains of swellings in lower limbs insidious in onset progressive
in nature Pitting type , no aggravating factor or relieving factors. Swelling is
not associated with pain or any trauma.
 
No history of increased bleeding during menses prior to pregnancy.
No history of exertional dyspnoea , palpitation, PND, giddiness.
No history of bleeding or leak PV.
No history of bleeding PR or malena.
No history of passing worms in the stools.
No history of burning micturation.
No history of cough with expectoration, hemoptysis, evening rise of
temperature or contact with a known case of tuberculosis.
No history of drug intake (anti-malarial drugs or aspirin).
No history of any yellowish discolouration of skin and sclera.
No facial puffiness seen
No history of loss of weight.
OBSTETRIC HISTORY:
Married Life – 13 years
 Non-consanguinous
Obstetric index – G3P2L2
 
N PRESENT
o. DELIVERY BABY AT BIRTH AGE COMMENTS

Cried soon after birth, Booked & Immunized(Had 3

FTVD, KIMS Male, 3.5 kg, Breast ANC visits + TT + IFA)Post
G1 Hospital Hubli . fed 2 years 4 years partum period – normal

FTVD, Baby cried soon after Booked & Immunized(Had 3

Government birth, Female, 3 kg, ANC visits + TT + IFA)Post
G2 Hospital Annigeri Breast fed – 2 ½ years 2 years partum period – normal
LMP – 06/01/2018
EDD – 14/10/2018
G.A ­-29 weeks +4days
 PRESENT PREGNANCY
 1st trimester-
 pregnancy was confirmed by urinary pregnancy test done at 2nd month
at annigeri hospital. Oral supplementation was not taken
 There was increase of 3 kg weight
 No history of nausea, vomiting or weakness
 No complaints of fever with rashes and preauricular
lymphadenopathy.
 No history of bleeding PV.
 No urinary symptoms
 No drug intake
 No history of craving for abnormal food (pica)
 
2nd trimester
Quickening in 5th month
1st ANC visit – 20 weeks, given TT, oral supplements not taken
Anamoly scan done at 24 week .

3RD trimester
Fetal movements present
No leak or bleed PV
No h/o pain abdomen
 
CONTRACEPTIVE HISTORY:
No history of using any contraceptive methods.

MENSTRUAL HISTORY:
Age of Menarche – 13 years
Past Cycles – Regular 30 days cycles with flow lasting 5
days, normal quantity, no pain or passing of clots.
LMP – 02/11/18
 
FAMILY HISTORY:
No history of congenital anomalies or twinning, DM,
HTN

PAST HISTORTY:
No history of Tuberculosis, seizure disorders, Asthma
No history suggestive of any cardiac ailments.
No history of previous surgeries, blood transfusions.
 
PERSONAL HISTORY:
Diet – Mixed
Appetite – Good
Sleep – Sound
Bowel & Bladder – Regular
Habits – No substance abuse

DIET HISTORY:
Consumes – 2100 kcal/day
Required – 2400 kcal/day
Deficit – 300 kcal/day
GENERAL PHYSICAL EXAMINATION:
Here is a pregnant lady 30 year old, moderately built
and nourished, conscious, alert cooperative ;well
oriented to time, place and person.

ANTHROPOMETRIC MEASUREMENTS
Weight – 50 kg
Height – 153 cm
BMI – 21.359kg/m2
 VITAL SIGNS
 Pulse -measured in right radial artery
 Rate-76 beats per minute
 Rhythm-regular
 Consistency of vessel wall-soft
 Volume-good
 Character-non collapsing
 Other peripheral pulses-normal
 There is no radio radial and radio femoral delay

  BP – Measured in supine position, right upper limb

110/68 mm of Hg
 
 RR – 14/min, regular
 
 SpO2 -98%
 Temperature – Patient is afebrile
 
GENERAL EXAMINATION
Pallor – Present
Icterus – Absent
Cyanosis – Absent
Clubbing – Absent
Oedema – Absent
Lymphadenopathy – Absent
Thyroid – Normal
Breasts – Normal
Spine – Normal
 
Head to toe examination
Scalp hair- black and lustrous
Eye-No Icterus
Ear and nose-normal
Face-No parotid swelling
Mouth-normal ,no glositis and stomatitis
Neck-no palpable lymph nodes and visible veins
Chest-normal.
Lower limb-bilateral lower limb edema from foot till
knee,pitting type.
 
SYSTEMIC EXAMINATION:
CVS – S1 S2 heard, No murmurs.
RS – Normal Vesicular Breath Sound heard, no basal
crepts.
CNS – No Abnormality detected
PA – Normal bowel sounds heard,No organomegaly
OBSTETRIC EXAMINATION:
INSPECTION:
Abdomen is uniformly distended, globular in shape
Umbilicus everted, hernial orifices normal
Flanks do not appear to be full.
 linea nigra present.
No scars over the abdomen

.
PALPATION: 
Abdominal circumference – 80 cm
Symphysio-fundal height – 28 cm .
FUNDAL GRIP – Soft, broad & non-ballotable, suggestive of breech
LATERAL GRIP – Knob like structures on the right side suggestive
of limb buds Uniform resistance on the left side suggestive of spine
1ST PELVIC GRIP – Smooth, hard, ballotable mass suggestive of
head
2ND PELVIC GRIP – Fingers converge, head not engaged.
Uterus is relaxed
Fetal weight = (29-12)*155 = 2635 gm

AUSCULTATION:
Fetal Heart sounds heard along the left spino-umbilical line
140/min, regular rhythmic
DIFFERENTIAL DIAGNOSIS
Pregnancy induced anaemia
most commonly Iron deficiency anemia other
differential diagnosis being
Other malnourishment disorder like
 Vitamin B12 deficiency
 Folic acid deficiency
Infection
Nephritis and preeclampsia
haemoglobinopathies
MANAGEMENT
INVESTIGATION
URINE
Albumin : Absent
Sugar : Absent

BLOOD
RBC : 2.35X106 /micro litre
WBC : 7.8X103 /micro litre
HGB : 7.3 g/Dl
HCT : 22.2%
MCV : 79.5fL
MCH : 27.1pg
MCHC : 29.9g/Dl
PLT : 361X103 /micro litre
Grouping : A+VE
Ultrasound Sonography: Impression – Single Live
Intrauterine pregnancy of 25 to 26 weeks
VDRL –non reactive
HIV :non reactive
HBSAG :negative
RBS :126mg/dl
Rubella :nil
Thyroid function test: Normal
Peripheral blood smear-
RBC s are microcytic hypochromic .
WBC are normal in Number and morphology.
Platelets are adequate
No parasites are seen

Stool examination –to rule out helminthic infestation

 TREATMENT

 Parenteral therapy with Iron sucrose compound ,sodium ferric

gluconate or Iron dextran through intravenous route
Intra muscularly Iron sucrose (20mg/ml),Iron dextran(Inferon)
(50mg/ml)
 Fersolate tablet containing 325mg of Ferrous sulphate which
contain 60mg of elemental iron ,traces of copper and manganese
given 30 min before meals till blood picture recovers
 Diet –A Realistic balanced diet rich in proteins ,iron and
vitamins and which is easily available
 To eradicate even a minimal septic focus by appropriate
antibiotic therpy.
 Albendazole to eradicate the hookworms if present.
SUMMARY
A 24 year old women of G3P2L2 with 29 weeks of
gestation, with Single live foetus with Cephalic
presentation with head not engaged and not in labour,
with Severe ANAEMIA along with symptoms like edema
in lower limbs and complaint of fever who undergone
two FTND type of delivery who have not taken any iron
supplements during present pregnancy with no
significant family and personal history but on
examination presents with pallor and other signs of
anaemia which may complicate her pregnancy.
 CONSUMING ENERGY DERIVED
1 CARBOHYDRATES 425g 1700kcal

2 FATS 45g 400kcal

3 PROTEINS 60g -
4 IRON 15mg -

Diet is deficient in carbohydrates and IRON .

Thank you