Anaemia in Pregnancy

ANAEMIA IN
PREGNANCY
ELSIE KULUWANI
Dept Obstetrics and Gynaecology
Ekwendeni College of Health Sciences
OBJECTIVES
• Definition
• Epidemiology
• Hematologic changes in Pregnancy
• Causes
• Prevention
• Classifying Anemia
• Management
• Complications
DEFINITION
• The decrease in the total number of red blood cells or Hemoglobin in
the blood which results in reduction of oxygen carrying capacity
• In pregnancy <11g/dl and <7g/dl (severe) at any gestation
CUT-OFF POINTS FOR DEFINING
ANAEMIA
The WHO further divided anaemia in pregnancy into;
Mild anaemia- Hb of >11-10.9 g/dl
Moderate anaemia-7.0 – 9.9 g/dl
Severe anaemia - < 7 g/dl
PHYSIOLOGICAL CHANGES IN
PREGNANCY
• There is an increase in plasma volume by 50% until 30 – 34 weeks
gestation.
• Total red mass increase of 20 %
 This result in haemodilution
 Haematocrit and haemoglobin decrease
• Significance of these changes
They safeguard mothers against adverse effects of blood loss during child
delivery
Meet demands of enlarged uterus and its increased vascular system
Protects the mother against effects of impaired venous return in supine and
erect position
EPIDEMIOLOGY
• Affects about 24.8 % i.e 1.62billion people (McLean et al, 2009)
• WHO estimates that 56% of women in developing countries have
anaemia.
• In Sub-Saharan Africa mostly caused by nutritional deficiencies
• Africa contributes to 90% of Worlds burden
• Malawi reported prevalence rate of;
 38.8 – 72 % ( Hb of <11 g/dl, cut off point)
 3.6 – 4 % for severe anaemia ( Hb < 7.0 g/dl,cut off point)
• Anaemia contributes 13% of the indirect causes of maternal mortality
MAIN CAUSES
• Physiological
• Hemorrhage
• Decreased Red Blood Cell Production
• Increased Red Blood Cell Destruction
1.PHYSIOLOGICAL ANEMIA
• Increase in Plasma volume
• Increases in RBC and Hemoglobin Mass
• Plasma Increase more than RBC > Hemodilution
2.HAEMORRHAGE
• Trauma
• GI bleeding
• APH (Placenta Previa, Abruptio Placenta)
3. DECREASED RED CELL
PRODUCTION
Nutritional
Deficiencies in the following
• Iron
• Vit A
• Vit B12
• Folic acid
Non-Nutritional
• Chronic disease: HIV, TB, Renal Failure
• Marrow Disorder: Aplastic anemia
4.INCREASED RED CELL
DESTRUCTION
Hemolytic
• Acquired: Malaria
• Drugs (Penecillin, Methyldopa, Cephalosporins etc)
• Hereditary Hb pathies:
• Thalassemia
• Sickle-cell
• Intravascular Hemolysis
• Malaria
• Sickle –cell disease
• Autoimmune Hemolytics anemias
• Microangiopathic Hemolytic anemia (Preeclampsia)
• Extravascular Hemolysis
• Reticuloendothelial System
MATERNAL RISK FACTORS
• Antenatal period
• Intranatal period
• Postnatal period
CLINICAL PRESENTATION
• Maternal physiologic changes alter the indexes used to diagnose anaemia and
nutritional deficiencies
• symptoms and signs are usually non-specific
 Fatigue
 pallor
 Headache
 Palpitations
 dizziness
 dyspnoea
 irritability.
 impaired temperature regulation
 poor concentration
 Asymptomatic
PREVENTION
• Early detection
• Iron and Folate supplementation (fefol once daily)
• Worm prophylaxis (albendazole 400mg)
• Malaria prophylaxis (SP 3) and insecticide treated nets
• Dietary education (leafy Veg, liver, fish eggs)
• HIV/AIDS prevention and treatment
• Birth Interval > 2yrs apart
WHAT ARE THE EFFECTS OF
ANAEMIA ON PREGNANCY?
TO THE MOTHER TO THE MOTHER
During pregnancy During labor
• Cardiac failure at 30 to 34 weeks • Uterine inertia
of pregnancy • Postpartum hemorrhage
• Increased susceptibility to • Cardiac failure
infection
• Shock
• Preterm labor
• Preeclampsia
WHAT ARE THE EFFECTS OF
ANEMIAN ON PREGNANCY?
TO THE MOTHER TO THE FETUS AND NEONATE
During puerperium • Prematurity
• Cardiac failure • IUGR
• Puerperal sepsis • Increased perinatal death
• Sub involution • Decreased iron stores in neonate
• Failing lactation
• Chronic ill health
MANAGEMENT
• Good History taking and Physical examination
• The following investigations can be done depending on the situation
 Full blood count- Haemoglobin, Mean corpuscular volume
 Grouping and cross match
 Iron studies
 Peripheral blood film
 Bone marrow aspirate
 Stool microscopy
 Urinalysis
 HIV test, CD4 count
MANAGEMENT
• Treat the underlying cause
• Treat with ferrous sulphate /folic and recheck hb in 2 to 4 weeks
• Urine and stool microscopy and treat according to results
• Treat malaria if indicated
• If haemoglobinopathy refer
• Transfusion
• Hb <7g/dl
• >7g/dl with Cardiac failure
• Moderate anemia with co existing conditions e.g Hemorrhage, Sepsis
INVESTIGATIONS
• FBC
• Peripheral smear
• Serum iron
• Bone marrow examination
• Urine analysis
• Stool analysis
• Serum protein
SPECIAL TEST
• Serum folate
• RBC Folate
• Serum Vit B₁₂
• Serum Bilrubin
• Coombs test
• HB electrophoresis
• NESTROF test
• Red cell osmotic flagility test
CLASSIFYING ANEMIA
• MEAN CELL VOLUME
• Microcytic Anemia (<80)
• Iron deficiency
• Normocytic Anemia (80-93)
• Acute Blood Loss
• Infection
• Hyperspleenism
• Macrocyitic Anemia (94 or >)
• Folate and Vit B12 Deficiency
• Folate 1-4mg od
• Vit B12 1000mcg IM every week x 4 weeks then 1000mcg monthly until the deficiency is
corrected
COMPLICATIONS
Adverse Birth Outcomes
• Spontaneous abortion
• Prematurity
• Intra Uterine Growth Restriction
• Low birth weight
• Neonatal death
Maternal
• Congestive Cardiac Failure
• Premature birth
• Mortality

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