By: P.

BWALYA
 Majority of pregnant women in
developing countries are grossly
anemic.
 Anaemia can cause death of mother
directly through heart failure or lead
to problems such as abortions,
premature labor, and intrauterine
death of the fetus, post partum
hemorrhage, or puerperal sepsis.
 There are many causes of anaemia
in pregnancy.
 Anaemia developing during
pregnancy continues afterwards, and
in most cases another pregnancy
follows before the woman recovers.
 The woman therefore suffers from
chronic ill health in most of her life.
 Anaemia is a reduction in the oxygen
carrying capacity of the blood; this may be
caused by a decrease in red cell production,
or reduction in haemoglobin content of the
blood, or a combination of these. (Myles
2003).
 Anaemia is a state in which the blood
haemoglobin level is below the normal range
for the patient’s age and sex. (CBoH, 2002).
 Anaemia in pregnancy is caused by a
combination of factors such as;
 Increased demand due to pregnancy.
 Deficient intake of role materials such
as iron, folic acid, or vitamin B 12.
 Acute or chronic blood loss.
 Increased red cell destruction.
 This is the most common cause of
Anaemia in pregnancy.
 The fetus takes something like 300mg
of iron from the mother.
 A further 700mg is needed by mother’s
own expanded blood volume, the
placenta, and the growing uterine
muscle.
 This means that there is usually a
negative balance as the normal diet
only affords some 3mg of iron daily to
the mother and only 10% of iron in the
diet is actually absorbed.
 Folic acid and vitamin B 12 are equally
on demand, and if the intake is not
increased deficient will occur.
 Multiple pregnancy increases the
demand on the mother’s resources
further.
 To manufacture normal red blood
cells the body requires protein, iron,
folic acid, and vitamin B12.
Deficiency can be due to;
 Lack of the right food or inadequate
food
 Poor appetite of the pregnant
woman
 Malabsorption due to chronic
diarrhea
 The woman might start the pregnancy
already lacking iron.
 This might be because of heavy menstrual
flows or bleeding in past pregnancies.
 These past pregnancies, which very often
follow each other very closely, might have
been complicated by antepartum or
postpartum haemorrhage or haemorrhoids
which will cause further loss.
 Further blood loss might be caused by hook­
worm infestation.
 Each worm is capable of extracting up to 0.05
ml of blood per day.
 In heavy infections the patient could have up
to 1000 worms. You should therefore check
the stool of every pregnant woman for
hookworm.
 If you have no laboratory facilities and you are
working in an area where hook­worm is
endemic you can give one dose of Vermox (5
tablets start) to deworm each woman in
pregnancy.
 When red cells grow old, they are destroyed
in the spleen and the liver.
 In -some pathological conditions where red
cells have a strange shape, such as in sickle-
cell disease, this destruction is accelerated
and the cells have a shortened life, especially
when the oxygen in the blood is low.
 As pregnancy advances the large uterus
prevents the lungs inflating fully.
 This leads to lower, oxygen
concentration in the blood and cell
destruction is increased.
 Infection with falciparum malaria also
leads to destruction and haemolysis of
the red cells.
 Folic acid is therefore used to replace
the destroyed cells. You should give
these women extra folic acid throughout
pregnancy and also give malaria
prophylaxis.
 A drop in haemoglobin level deprives
the tissues of adequate oxygen.
 The symptoms of anaemia are in fact
symptoms of oxygen lack (CBoH,
2002). These include the following;
 Weakness
 Tiredness
 Dizziness
 Breathlessness on exertion
 Heart palpitation
 Parasthesia in fingers and toes
 Headache
 Apathy
 Increased heart rate
 Restlessness
 Air hunger
 On examination
 Pallor of the skin, mucus
membranes, palms of hands and
conjunctivae.
 There may be oedema
 Tachycardia
 Examination with stethoscope
reveals systolic heart murmurs
 The management of patients with anaemia
depends upon the severity of the condition.
 Regimens will vary according to the
prevalence of anaemia, the size of your unit
and its facilities.
 If the problem is diagnosed before the 30th
week of pregnancy then mostly anaemia can
be improved sufficiently within the remaining
ten weeks so that labour is no longer a danger
as it would be to a very anaemic woman.
 In pregnancy the blood is always
slightly diluted because of the
increased fluid volume of the body.
 Therefore a pregnant woman's
haemoglobin is always about 2g per 100
lower than when she is not pregnant.
 In East Africa women with haemoglobin
estimations below 5g per 100 ml should
be considered anaemic and managed as
follows:
• Hb above 9g%
Follow up regularly in the antenatal
clinic and double the normal dose of folic
acid 10 mg per day) and the normal dose
of ferrous sulphate (600 mg per day).
• Hb below 9g% but above 7g%
Admit to a hospital where usually a total
dose infusion of iron (as Inferon) will be
given (if the pregnancy is less than 36
weeks) and the woman will be
discharged on the regimen above.
 Hb below 9g% in the last 4 weeks of
pregnancy- These patients, together
with those with an Hb below 7g% at any
stage of pregnancy, should be admitted
to hospital for blood transfusion
followed by a total dose iron infusion.
 Heart failure is likely to occur in all cases
of severe anaemia in pregnancy.
 The heart is weak because of the anaemic
state yet has to pump an increased fluid
volume.
 This will precipitate heart failure.
 The patient presents with peripheral
oedema (especially of the feet),
pulmonary oedema and a large tender
liver.
 If such a patient goes into labour untreated
she is likely to die.
 Treatment consists of administering a
diuretic, in addition to the normal practice
of giving digoxin.
 Once some fluid has been cleared, a slow
blood (or, better, packed-cell) transfusion is
set up.
 Obviously these women have to be managed
in hospital, with intensive diuretic therapy
being given along with the blood.
 If any woman presents at a rural health
unit with anaemia and cardiac failure
(i.e. breathlessness at rest, a fast
irregular pulse, peripheral and
pulmonary oedema) give digoxin 0.5 mg
im and Frusemide 40 mg iv as an
emergency measure, while transport to
the hospital is being arranged.
 Transport her in the half-seated
position.
 ON THE MOTHER
 Maternal death due to multiple organ
failure such as heart failure and renal
failure.
 This may come about due to increased
cardiac workload to compensate for the
reduced haemoglobin as well as
insufficient nutritional supply to the heart.
 Renal failure is due to reduced blood flow
to the kidneys.
 Abortions usually in the second trimester
caused by haemolysis of parasitized cells
which eventually lead to anaemia
 Premature labour
 Post partum haemorrhage due to
reduced platelet count
 Puerperal sepsis as a result of reduced
immunity due to low immunoglobulin.
 Venous thrombosis due to reduced
mobility
 ON THE FETUS
• Intra uterine fetal death due to
insufficient nutrients and oxygen
• Intra uterine growth retardation due to
inadequate nutrients to the fetus.
• Fetal distress due to insufficient oxygen.
• Asphyxia due to insufficient oxygen.
• Low birth weight as a result of reduced
nutrient supply.
• Prematurity due to reduced oxygen and
nutrients
• Instruct the community on proper dietary
habits. Each family should have a vegetable
garden, and green vegetables should not be
overcooked as this destroys the folic acid.
• Encourage the mother to practice child spacing
so that there is time between each pregnancy
for her to replenish her body resources.
• Teach proper disposal of faeces to avoid
hookworm infestation.
• Where possible people should wear shoes.
 Conduct mass campaigns to eradicate
hookworm and control of malaria.
 Prevent or treat antepartum and
postpartum haemorrhage adequately.
 In the meantime give the following
supplements to each woman through­
out the pregnancy:
Ferrous sulphate 200 mg three times
a day
Folic acid 5 mg daily.
 Give Fansidar after sixteen weeks of
gestation period and continue every
fourth week( three doses)
 Reduce hookworm by deworming all
pregnant women.
 Detect the anaemia early and give
adequate treatment.
 Encourage mothers to sleep under the
mosquito net
END OF PRESENTATION