dr. odawa - anaemia in pregnancy odw

8/12/2019 Dr. Odawa - Anaemia in Pregnancy Odw

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ANAEMIA IN PREGNANCY

MBCHB IV

PRESENTED BY:

DR. F.X. ODAWA


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ANAEMIA IN PREGNANCY

An expectant mother is considered to

have anaemia if her HB level is < 10g/dl.

(WHO:


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Normal ranges: Female: 12-16g/dl

Male: 13-18g/dl

Anaemia is the most common medical

disorder to occur in pregnant women

particularly in developing countries butits prevalence varies from region to

region.


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It is a major contributor to

maternal morbidity and mortality and is

also associated with perinatal mortality.


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Causes

Are multifactorial and include:

1) Nutritional deficiencies of iron and

folate- Poor dietary intake

- Poor absorption

- Increased nutrient loss and demand- Methods of cooking

- Dietary habits


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Causes Cont

- Prohibitive costs

- Some food taboos for pregnant women

NB: Absorption of iron is affected by the

high phytate content in many grains

based diets in the tropics.


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2).Malaria infestation

With its attendant haemolysis increases

folate demand leading to megaboblastic

anaemia.

Natural acquired immunity is lowered in

pregnancy leading to excessive

destruction of RBCs in some cases.


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3). Hookworm infestation:

Chronic parasite infection affects millionsof women of reproductive age indeveloping countries.

Lives in the duodenum - the site ofoptimal iron absorption, thereforeinterfering with the latter by theirattachments to the duodenal mucosabesides sucking blood from the patient(0.050.1ml per worm/ day), and leadsto iron deficiency.


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4)Other helminthes and parasites e.g

E. histolytica

5) Haemoglobinopathese.g. sickle cell

disease (SCD), thalasaemia and glucose

6-phosphate dehydrogenase deficiency.


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SCD is the most common inherited

anaemia in the world.

The anaemia in SCD is related to theshortened red cell survival (average 17

days) so that these patients suffer from a

chronic haemolytic process reflecting

itself in the form of a crisis in the motherand IUGR in the foetus. The steady state

HB in SCA is between 6-10%.


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6). Chronic diseases e.g. TB, HIV,

Brucellosis, scistosomiasis, UTI, chronic

liver and renal dx, and protein deficiency.


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7) Demands of pregnancy parse;

Extra demands to the haemolytic factors

(increased red cell mass plus demands of

the growing foetus = increase in the total

number of rapidly dividing cell leads toincreased requirement of folic acid).


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Clinical Features

Characteristically insidious in onset

Presentation usually non-specific and depends

on the severity of anaemia, duration of disease

and causative factors. Diagnosis depends on history, physical

examination and various lab tests done based

on aetiological factors.

In the early stages it may only be detected by

routine HB estimation in the ANC.


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Symptoms include:

- General weakness, malaise, fatigue,

lethergy or lassitude

- Dizziness- Dyspnoea on slight excertion

- Breathlessness

- Swelling of legs feet and face (oedema)


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Signs include:

palour (conjunctiva, tongue, palms and nail

beds, sole of the feet etc),

jaundice (or tingue of),

Moderate tachycardia at rest,

Haemic murmur,

low grade fever without obvios cause is

common plus or minus hepatosplenomegaly inhaemolytic anaemia e.g. of malaria (endemic)

and SCD,


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Orthorpnoea and other signs of cardiac

failure e.g. engorged neck veins in the

semi-upright position, congestion of lungbases, enlarged tender liver, increased

pulse pressure, and may be present in

very severe cases

Albuminuria is common


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In the terminal phase acute pulmonary

oedema may supervene and cerebral

anoxia may produce excitement andmental confusion followed by loss of

consciousness.


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InvestigationsHgram + PBF+ BS for MPs

Stool: O/C

Hb electrophoresis/ sickling test

LFTs for serous proteins as in chronic liver

disease and hypoproteinaemia

U/Es + Cr + U.A to rule out underlying nephrosis

CXR- to r/o intercurrent chronic chest infection


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Sequale of Anaemia in pregnancy

CCF= death in pregnancy or soon after

delivery or during labour

Low resistance = infections e.g.pneumonias, puerperal sepsis etc

IUGR

Late abortions (2028 wks) Premature labour


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IUFD/ neonatal death (perinatal death)

due to intrapartum asphyxia

Infantile anaemia 2-3 months post

delivery due to deficient iron storage in

the last trimester.


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Treatment

Mainly directed at the cause

Supportive care is similarly importante.g. administration of haematinics or

blood transfusion or bothdepending on

the degree of anaemia and the

gestational age at the time of diagnosis.


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General Measures

Protein intake- Should be adequateat

least 100grams per /day, 50% of which

should preferably be animal proteinChronic diarrhoeas should be treated

as they interfere with folic acid and B12

absorption

Hookworm

should be treated withnon-toxic antihelminthics


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Specific treatment

1).Oral iron therapy; in Fe def. anaemia ofmoderate degree in the first and secondtrimester

2).Parenteral iron therapy; in more severecases particularly those seen for the first timenear term to achieve quicker response as wellas for those not able to tolerate oral Fe due togastric symptoms and also those notresponding due to malabsorption.


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3).Suplementary Folic Acid

4). Malaria treatment when confirmed or

suspected5).Steroid therapyin excessive

haemolysis

6).Vit. B12for megaloblastic anaemia

unresponsive to folic acid or when B12

def.is confirmed


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7).Cardiac failure- treated appropriately with

antifailure regime (digoxine, aminophyline, O2

etc

8).Blood transfusionfor impending CCF,

patient in labour with severe anaemia

- watch for overload

- Packed RBCs is preferred

- Transfuse slowly (not more than 500mls in

at least 6-8 hrs


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Mx of labour and the

puerperium in severe anaemia

Labour and the first 2wks of the

puerperium are the periods of greatest

danger to the anaemic mother.Most deaths occur in the first 12hrs after

delivery

O2 should be delivered in labour by

mask to reduce the risk of foetalasphyxia


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Aseptic techniques to be employed due

to decreased immunity

2nd

stage should be shortened byassisted vacuum extraction or low

forceps delivery

Antibiotic prophylaxis in the puerperium

Specific treatment for anaemia to

continue for at least 6wks after delivery

(puerperium) to accelerate recovery


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Finally before discharge warn the mother

of possibility of recurrence in subsequent

pregnancies therefore to present assoon as they become pregnant for

prophylaxis


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Prevention

a) Correct faulty dietary habits e.g.

overcooking vegetables and meat

(important sources of folic acid)b) Increase production and consumption

of foods which contain the raw

materials of erythropoesis.

c) Antimalarial prophylaxis


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d) Reduction of hookworm loads

e) Prophylactic medicationhaematinics

f) Early detection of anaemia inpregnancy by screening all pregnant

women (ANP)first and last visits


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These measures will lead to a

reduction in loss of maternal and

infant lives from anaemia and alsoreduce cost of hospitalization and

treatment


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Conclusion

Prevention of anaemia is difficult in

developing countries due to its

multfactorial origin:- Poor SES

- Poor health facilities

- Socio-cultural factors

- Poor utilization and scarcity of FP and

ANC services


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However prophylactic use of haematinics

and antimalarials has reduced the

severity of anaemia in the tropics.

dr. odawa - anaemia in pregnancy odw

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