MANAGEMENT OF ANAEMIA IN PREGNANCY

FIRM II Presentation 2006

Supervisor;Prof.Massawe.

A 31 years old primigravida with 20 weeks gestational age,has unremarkable medical history,complains of easy fatiguability and lack of stamina for daily activities.she has unusual urge to eat rice and clay(pica), On examination tachycardia(heart rate 105),pallor,fetal heart rate 140. DDX????

Components
.Definition .Aetiology .Epidemiology .Management .Complications

Definition
Anaemia in pregnancy is the Haemoglobin of less than 11g/dl. Severe Anaemia is Haemoglobin of less than 7.0g/dl. Very severe anaemia is Hb less or equal to 4g/dl. Cut off point for referral is 8.5g/dl

Aetiology
Nutrition Iron deficiency Folic acid deficiency Vit B 12 deficiency Haemolysis Haemoglobinopathies eg. Sickle cell disease Drug induced Autoimmune-(rare)

Aetiology cont.
Infestation Hookworm-Necator americanus -Ancylostoma duodenale

Infection Amoebic dysentry Bacillary dysentry

Haemorrhageeg.APH

Epidemiology

Highly prevalent in pregnant women Developing countries 56%,developed countries 18%,in Africa 50-60%. In Tanzania prevalence among pregnant women at booking 60%. Among primigravida 75%(Massawe et al 1996,99)

Epidmiology cont..

Anaemia also is prevalent among non-pregnant women in reproductive age group. Study in Dar,the prevalence was 50% among non-pregn,nonlactating women. At MNH anaemia is number one reason for admission during antenatal.

Clinical features

Mainly patients are asymptomatic Early symptoms -Easy fatiguability -Palpitations -Dizziness.

Clinical features
Late -Chest pain -Dyspnoea -Orthopnoea -Swelling of lower limbs

MANAGEMENT
Diagnosis mainly based on:-History -Physical examinations -Investigations.

Investigations

FBP -Hb level,Blood grouping&cross matching -Rbc morphology -Reticulocyte counts -Wbc count. Bs for MPs Sickling test Coombs test

Investigations cont.

Plasma total serum Iron Folic acid &Vit B 12 assay. Stool-ova&occult blood Urinalysis.

Treatments
Depends on Gestational age,Severity and the cause the anaemia. Also it depends whether the treatment is Antenataly or During labour.

Treatments cont
Severity-Hb level <6g/dl -Hb level 6-8.5g/dl -Hb level 8.5-11.7g/dl Gestational age-cut off point 34 wks Note -Moderate,Mild and Hb level of less than 6 need blood transfussion. -Asymptomatic,Gestational age of below 34wksHaematenics. -Gestational age above 34wks-bt

Treatment cont
Drugs Ferrous sulphate 200mg tds 1/12 FA 5mg od 2/52. Inferon I/m Note Investigate and treat the cause.

Treatment cont
During labour -Nurse the patient in a propped up position. -Blood for Hb,grouping&cross matching. -catheterize -Administer frusemide 80mg iv. -Deliver the patient--assist 2nd stage of labour by vacuum extraction. -

Treatment cont

Active management of 3rd stage of labour -Oxytocin 10 IU I/m immediately after delivery of anterior shoulder -Cord traction. -Squeezing out clots after delivery of placenta.

Treatment cont
Transfuse slowly packed cells 24 hrs post delivery(one unit for 4hrs). Do not give blood transfusion while in labour.

Treatment cont
Monitor vital signs every 30min. Monitor input&output Monitor closely signs of heart failure Investigate and treat underlying cause Give ferrous sulphate200mg every 8hrs&FA 5mg od for 6wks.

Complications of Anaemia in pregnancy.

To the mother-cardiac failure -puerperal sepsis

To the child-Abortion -premature delivery -IUGR -Still birth.

Thanks