Anaemia in Pregnancy

Define anaemia in Pregnancy

Prevalence of Anaemia in pregnancy
Outline causes of anaemia in pregnancy
Describe signs and symptoms of anaemia
Describe the management of anaemia
Describe the complications of anaemia in
pregnancy
 Anaemia in Pregnancy is defined as a Hb < 10 g
/dL.
Anaemia is a cause of considerable perinatal
morbidity and mortality
 Varies
because of differences in socioeconomic
conditions, lifestyles and health-seeking behaviours
across different cultures.
Anaemia affects nearly half of all pregnant women
in the world:
- 52% in developing countries
- 23% in the developed world
 Botswana recommend routine iron supplementation
to all pregnant women

Botswana guidelines Hb done at 1st visit, 20-24

wks, and 34-36 weeks
 Multiparity (short birth intervals)
HIV infection
Multiple pregnancy
Parasitic infestation eg hookworm , schistosomiasis
Malaria Haemolytic anaemia
Poor diet nutritional anaemia
Physiological hemodilution in pregnancy
Haemorrhage APH or bleeding in early preg
Drugs eg PMTCT AZT
Haemoglobinopathies
 Symptoms:
- General body weakness
- Dizziness with episodes of fainting
- Palpitations
- Breathlessness
 Pallor of mucus membranes (conjuctiva &
tongue)
Jaundice in hemolytic anaemia of malaria and
sickle cell disease
Splenomegaly
Koilonychia in chronic iron-deficiency anaemia
Oedema
Tachycardia
 History and physical exam
Nutrition
Diet
HIV status
All pregnant mothers with anaemia should be subjected to
investigations
FBC with differential and reticulocyte count
Blood slide for malaria parasites
Stool examination for parasitic infestation
Urine for analysis, microscopy and culture to exclude chronic renal disease
HIV test
If
anaemia persists despite negative results and treatment, the
patient must be referred for 2nd line mx at a higher level facility
Stage of Pregnancy MILD 8.1-10g/dl SEVERE <7g/dl

Preterm Oral haematinics Parenteral transfusion

Diet advice Diet advice

Term Oral haematinics Transfusion
Diet advice Oral haematinics
Diet advice
Intra-partum Transfusion
Post-partum Oral haematinics Transfusion
Diet advice Oral haematinics
Diet advice
 Correction of anaemia without establishing the
cause gives only a temporary solution to the
problem
Transfusion depends on pts condition
Consider change of HAART treatment if Hb drops
< 7.5g/dl per National HIV/AIDS Guidelines
 Open vein with large cannula (size 16G)
Put up fluids, NS/RL
Give Furosemide 40mg IV
Have baseline vitals
Fluid balance ( oral , IVF , urine output)
 Document in the record:
Time transfusion started
Time tranfusion completed
Volume and type of all products transfused
The unique donation numbers of all products transfused
Any adverse effects
 For each unit of blood transfused, monitor the
woman at the folllowing stages:
Before starting the transfusion
At the onset of transfusion
15 minutes after starting the transfusion
At least every hour during transfusion
Monitor: general appearance, temperature, pulse, BP and
respirations
 Obstetric haemorrhage
Antenatal infections
Preterm labour
Abortion
Cardiac failure (shock)
Puerperal sepsis
Maternal death
 Prematurity
IUGR
IUFD
Foetal malformation