Anaemia in Pregnancy

 Anaemia :

It is the reduction in the Oxygen carryingcapacity of the blood. It is the reduction in the quantity and quality of the red blood cells and haemoglobin levels.

 

Anaemia in Pregnancy: 

It is a condition in pregnancy inwhich the hemoglobin level is less than 11g/dl and packed cell volume is less than 33%. Anaemia in pregnancy is a common cause of maternal mortality

 

There are 2 types of anaemia in pregnancy Physiological

 

Nutritional or pathological

 

Physiological Anaemia in Pregnancy

 

During pregnancy, the maternal blood ties to compensate for the blood being used by the fetus from the mother thereby causing increase plasma volume of the maternal blood which gradually increases by 50%. This usually occurs in the mid-trimester.

 

Also, there is increase in red blood cells towards the later part of pregnancy to about 25%. This results in haemodilution (which is an increase of plasma in the blood in proportion to the cells) which causes fall in haemoglobin concentration. These physiological changes are not pathological but are necessary for the development of the foetus in pregnancy.

  

Nutritional or Pathological Anaemia In Pregnancy 

During pregnancy, approximately 1500mg of iron is needed

 

for the increase in maternal hemoglobin (400-500mg) the fetus and placenta (300-400gm) replacement of daily loss through stools, urine and skin (250mg) replacement of blood loss at delivery (200mg). About 95% of pregnant women with anaemia have the iron deficiency type.

 

Causes

 

·              Reduced intake or absorption of iron as a result of iron deficiency in diet and gastro – intestinal disturba nces (as in morning sickness).

 

·              Withdrawal of iron by fetus

 

·              Folic acid deficiency resulting from haemolysis, malaria , hemoglobinpathy, inadequate intake ,malabsorption of folic acid

 

·              Excess demand due to multiple pregnancy, multiparty, chronic inflammation especially urinary tract infection.

 

·              Hemorrhage, antepartum or post partum hemorrhage, hookworm.

 

Signs and Symptoms

 

Mother

Pallor of mucus membranes

 

Lassitude (always tired) Fainting, Dyspnoea, Tachycardia and palpitations

 

Reduced resistance to infection – Puerperal sepsis Potential threat to life.

 

Fetus/Baby

Increase risk of abortion

 

Increased risk of intrauterine hypoxia and growth retardation Preterm birth, Low birth weight

Increased risk of perinatal morbidity and mortality

 

Management

·              Good ante-natal care

 

·              Intake of diet rich in iron, diet rich in protein, minerals and vitamins

 

·              Reduce workload and stress. Encourage rest

 

·              Early recognition and treatment for anaemia .

 

·              Drugs/medication

Ferrous sulphate – 200mg tab b.d or t.d.s

Ferrous gluconate  - 300mg tab 1.e 2 tab b.d

 

·              Blood transfusion might be given to treat severe anaemia.

 

·              Treatment for worm if present.

 

Folic Acid Deficiency Anaemia

 

It is a type of anaemia in pregnancy which there is a physiological disease in serum folate levels which occurs towards the end of pregnancy.

 

Causes

·              Reduced dietary intake

 

·              Threaten  abortion

 

·              Interference with utilization e.g. drugs like anti conversant

 

·              Excessive demand and loss as in multiple pregnancy

 

Investigations

Packed cell volume, Full blood count

 

Signs and Symptoms

 

pallor,lassitude, weight loss, depression, nausea and vomiting, glossitis, gingivitis, diarrhoea.

 

Management

·              Folic acid therapy: 5mg  orally daily

 

·              Encourage diet rich in folic acid e.g. green vegetable, bananas, citrus fruits, pears, peanuts.

 

·              Ensure adequate rest.

 

Sickle Cell (Disease Anaemia in Pregnancy)

 

Sickle cell disorders are found most commonly in people of African or west Indian origin.

In this condition defective gene produce abnormal haemoglobin beta chains: the resulting Hb is Hb SS.

 

Sickle Cell Anaemia: Sickle cells have an increased fragility andshortened life span of 17 days resulting in chronic haemolytic anaemia and causing episodes of ischaemia and pain; these are known as sickle cell crisis. Women with sickle cell anaemia may be subfertile but those who do become pregnant may already have organ damages.

 

Precipitating Factors to Crisis;

 

Psychological stress, cold climate, extreme temperature changes, smoking , induced hypoxia, strenuous physical exercise, fatigue, respiratory disease and pregnancy.

 

Signs and Symptoms

 

Jaundice, Anaemia, fatigue, joints pain, epigastric pain, vomiting, abdominal tension, splenomegally, hepatomegally, pyrexia.

 

Effect On Foetus

·              Risk of early abortion

 

·              premature birth

 

·              Intra uterine death

 

Effect on Mother

·              Low immunity.

 

·              Risk of embolism

 

Ante Natal Care

·              Refer to bigger hospital with better equipments for care

 

·              Regular monitoring of haemoglobin level

 

·              Anti-malaria therapy

 

·              Folate supplements

 

·              Blood transfusion every 6 weeks if necessary.

 

·              Advise woman to avoid situation that will precipitate a crisis.

 

·              If crisis occurs, admit patient, rehydrate, treat infection, relief pain, give oxygen therapy and blood transfusion.