obgyn anemia in pregnancy for ug class
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Anemia in Pregnancy
Prof. Vinita Das
HOD Ob/Gyn
KGMU Lucknow
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Learning Obecti!es
Diagnose anemia in "regnancy
Learn t#e effect on mot#er $ fetus
Learn %/% in "regnancy
Learn "re!ention of anemia
Learn su""&ementation of ora& iron 'uring "regnancy
Management of anemia 'uring "regnancy
Labor $ De&i!ery management
(ationa& anemia contro& "rogram
Post "artum contrace"tion
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)ackgroun' *nformation
+ommonest me'ica& 'isor'er in "regnancy
Pre!a&ence in *n'ia !aries between ,--0
Pre!a&ence in U%A is 120
(utritiona& anemia 34e 'eficiency5 is commonest
*t is im"ortant contributor to materna& $ "erinata&
morbi'ity $ morta&ity as a 'irect or in'irect cause
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Definition Anemia
A con'ition w#ere circu&ating &e!e&s of Hb are6uantitati!e&y or 6ua&itati!e&y &ower t#an norma&
(on "regnant women Hb 7 81gm0
Pregnant women 39HO5 Hb 7 88 gm0
Haematocrit 7 ::0Pregnant women 3+D+5 Hb 788 gm0
8st$:r' ;rimester
1n' trimester Hb 7 8-., gm0
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*+M< Anemia %e!erity +&assification
Hb !a&ues
Mi&' 8-.-8-.= gm0
Mo'erate =.=
%e!ere 7
Very %e!ere 72
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+auses of Anemia in Pregnancy
(utritiona& / *ron 'eficiency anemia
Pre"regnancy "oor nutrition !ery im"ortant
)esi'es *ron> fo&ate an' )81 'eficiency a&so im"ortant
+#ronic b&oo' &oss 'ue to "arasitic infections ? Hookworm $ ma&aria
Mu&ti"arity
Mu&ti"&e "regnancy
Acute b&oo' &oss in APH> PPH
sick&e ce&& anemia
A"&astic anemia is rare
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Pat#o"#ysio&ogy of (utritiona& Anemia in
Pregnancy
Augmente' eryt#ro"oiesis in "regnancy
)&oo' !o&ume increases 2-2,0 in "regnancy
*ncrease in "&asma is more as com"are' to re' ce&& mass&ea'ing to #emo'i&ution $ 'ecrease in Hb &e!e&
*ron stores are 'e"&ete' wit# eac# "regnancy
;oo soon $ too many "regnancies resu&t in #ig#er"re!a&ence of iron 'eficiency anemia
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@tra *ron
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4actors stimu&ates stemce&&s in )one Marrow5> ;#yroine> An'rogens
;race e&ements ? Binc 3a&so im"ortant for "rotein synt#esis $(uc&eic aci' metabo&ism5> +oba&t> +o""er
Vitamins ? Vit )81 re6uire' for synt#esis of
4o&ic aci' 3Vitamin =5 re6uire' in &ater stage for D(A synt#esis
Vitamin + necessary for con!ersion of fo&ic aci' to fo&inic aci'> iten#ances absor"tion of iron from sma&& intestine
Pyro'oine )C usefu& a'u!ant in eryt#ro"oeisis
Vitamin A re6uire' for ce&& growt#> 'ifferentiation $ maintenance ofintegrity of e"it#e&ium> immune function
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P#armacokinetics of *ron / 'ai&y re6uirement
(orma& 'iet contain about 82mg of iron
Absor"tion of iron is ,8-0 381 mg5 $ :20 in "ure !eg 'iet
A''itiona& 'ai&y iron 'eman' inear&y "regnancy 1: mg/'ay
*n &ate "regnancy C mg/'ay
%o 'ai&y su""&ement of 2-C-mg of e&ementa& iron isre6uire' 'uring "regnancy
4o&ic aci' re6uirement is a&soincrease' 2--C-- ug/'ay
*n strict !eg Vit ) 81 is a&so'eficient
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+&inica& Presentation
De"en's on se!erity of anemiaHig# risk women ? a'o&escent> mu&ti"arous> mu&ti"&e"regnancy> &ower socio economic status
Mi&' anemic asym"tomatic
%ym"toms ? "a&&or> weakness> fatigue> 'ys"noea>"a&"itation> swe&&ing o!er feet $ bo'y
%igns ? "a&&or> facia& "uffiness> raise' VP> tac#ycar'ia>tac#y"nea> cre"ts in &ung bases> #e"atos"&enomega&y>"itting oe'ema o!er ab'omina& wa&& $ &egs
Haemic murmur> car'iac fai&ureG&ossitis> stomatitis> c#e&osis> britt&e #air
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@ffect of Anemia on Pregnancy $ Mot#er
Hig#er inci'ence of "regnancy com"&icationsP@;> abru"tio "&acentae> "reterm &abor
Pre'is"ose' to infections &ike ? U;*> "uer"era& se"sis
*ncrease' risk to PPH
%ubin!o&ution of uterus
Lactation fai&ure
Materna& morta&ity ? 'ue to +H4>
+erebra& anoia>
%e"sis>
;#romboembo&ism
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@ffect of Anemia on 4etus $ (eonate
Hig#er inci'ence of abortions> "reterm birt#> *UG<
*UD
Low APGA< at birt#
(eonate more susce"tib&e for anemia $ infectionsHig#er Perinata& morbi'ity $ morta&ity
Anemic infant wit# cogniti!e $ affecti!e 'ysfunction
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Most +ritica& Perio'
1E:- weeks of "regnancy
*n &abor
*mme'iate&y after 'e&i!ery
@ar&y Puer"erium
+H4
34ai&ure to co"e u" wit# "regnancy in'uce'
car'iac &oa'5
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9ork U" of Pregnancy wit# Anemia
Detai&e' H/o ? age> "arity> 'iet> c#ronic b&ee'ing>worm infestation> ma&aria> race etc
@aminationPa&&or
G&ossitis
%"&enomega&y ? #emo&ytic anemia
aun'ice ? #emo&ytic anemia
Pur"ura ? b&ee'ing 'isor'er
@!i'ence of c#ronic 'isease ? ;)
Anasarca $ signs of car'iac fai&ure in se!ere cases
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*n!estigation
%e!erity of anemia ? Hb $ Haematocrit> at first !isit> 1E:-weeks $ :C weeks
;y"e of anemia ? G)P microcytic> macrocytic> 'imor"#ic>normocytic> #emo&ytic> "ancyto"enia
)one marrow acti!ity ? reticu&ocyte count 3( .1105>#ig#er bone marrow acti!ity is seen in #emo&ytic anemia
fo&&owing acute b&oo' &oss
iron 'ef anemia on treatment+ause of anemia ? by !arious in!estigations
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G)P %taine' wit# Leis#man stain
(orma& smear ? (ormocytic 3(orma&
siFe normoc#romic 3(orma&
co&our
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microcytic
M+H 'ecreasesM+H+ ? 'ecreases> one of t#e most sensiti!e in'ices
3(1C:-05
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%"ecia& *n!estigations
%erum 4erritin ? abnorma& if 7 1- ng/m& 3( 2-8C- ng/'&5>
assess iron stores
%erum *ron ? ( C,8C, ug/'&> 'ecreases in 4e 'ef
anemia
%erum *ron bin'ing ca"acity ? :--:C- ug/'&> increases
wit# se!erity of anemia
Percentage saturation of transferrin ? :,,-0>
'ecreases to &ess t#an 1-0 in fe 'ef anemia
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Differentiation between iron 'eficiency anemia $ ;#a&assemia
='iminis#e' synt#esis of Hb b c#ains in ;#a&assemia5
*n!estigations (orma& !a&ues 4e Def Anemia ;#a&assemiaM+V ,=C f& re'uce' V re'uce'
M+H 1::"g re'uce' V re'uce'
M+H+ :1:, gm/'& re'uce' ( or re'uce'Hb4 71 0 norma&
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Ot#er *n!estigations
Urine eamination ?
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;reatment for *ron Deficiency Anemia
*m"ro!ing 'iet ric# in iron $fruits $ &eafy !egetab&es
;reat worm infections>maintain genera& #ygiene
4oo' fortification wit# iron $
genetic mo'ification of foo' *ron $ fo&ic aci'
su""&ementation in young gir&s$ 'uring "regnancy
Heme iron better> "resent inanima& foo' $ is betterabsorbe'
*ron absor"tion en#ance' bycitrous fruits> Vit +
A!oi' tea> coffee> +a>"#ytates> "#os"#ates>oa&ates> egg> cerea&s wit# iron
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*ron
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*ron su""&ementation in Pregnancy
C- mg e&ementa& iron $ 2-- ug offo&ic aci' 'ai&y 'uring "regnancyan' : mont#s t#ere after
*n anemia t#era"eutic 'oses are8E-1-- mg /'
g&uconate> succinate> su&fate>ascorbate
+arbony& iron better to&erate' Ora& iron can #a!e si'e effects &ike
nausea> !omiting> gastritis>'iarr#oea> consti"ation
*ron su""&ementation not
recommen'e' in first
trimester Hig#er inci'ence of
miscarriage )irt# 'efects
)acteria& infection 3bacteria
grow after taking iron from
su""&ementation5
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Ora& *ron
Hb E88 gm0> ear&y "reg
+ontrain'ication to Ora& *ron;#era"y *nto&erance to ora& iron
%e!ere anemia in a'!ance'"regnancy
(on com"&iant
4ai&ure to
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Parentera& *ron ;ransfusion
*ron sucrose for "arentera& use
Dose ca&cu&ate' 9t in Kg
iron 'eficit 1.1 I 8--- mg for
iron stores
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*n'ications for )&oo' ;ransfusion
%e!ere anemia first seen after
:C weeks of "regnancy
Anemia 'ue to acute b&oo'
Loss ? APH $ PPH
Associate' *nfection
Patient not res"on'ing to ora&
or "arentera& t#era"y
Anemic $ sym"tomatic
"regnant women 3'ys"neic>
wit# #eart fai&ure etc5irres"ecti!e of gestationa& age
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Management of Labor
Labor s#ou&' be su"er!ise'Pro"er counse&ing $ consent to be taken
)&oo' 3w#o&e $ "acke'5 ke"t cross matc#e'
9omen nurse' in "ro""e' u" "osition
*ntermittent O1 to be gi!enPrecaution to "re!ent infection $ b&oo' &oss
%trict ase"tic "recautions $ minima& P/V eams
Pro"#y&actic antibiotic can be gi!en
Patent i! &ine but f&ui's are a!oi'e' *n 'ecom"ensate' "atient 'iuretic gi!en
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%econ' $ ;#ir' %tage of Labor
%econ' stage cut s#ort by force"s or !entouse
Acti!e management of :r' stage of &abour to be 'one
Oytocics> P/< miso"rosto& can be gi!en after 'e&i!ery of
fetus *nection met#ergin i! contrain'icate'
@!en norma& b&oo' &oss may be to&erate' "oor&y in
anemic "atient
*V 4rusemi'e gi!en after 'e&i!ery to 'ecrease car'iac&oa'
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Pregnant woman is consi'ere' anemic w#en #er Hb is
be&ow 3unit gm/'&5
A. 81
). 88
+. 8-D. =
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Most common cause of anemia in "regnancy in
*n'ia is
A. (utritiona& anemia
). Parasitic anemia
+. A"&astic anemiaD. ;#a&assemia
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*ron 'eficiency anemia can be 'iagnose' ear&iest
by w#ic# &aboratory test
A. Hb0
). %erum ferritin
+. %erum ironD.
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9#ic# com"&ication is not common in Pregnancy
wit# anemia
A. P*H
). Preterm &abour
+. GDMD. Puer"era& se"sis