Anemia with pregnancy

Definition Is defined as a haemoglobin concentration less than

10.5gm /dl , or if hematocrit falls to less than 30%.( WHO) Problem in the Jordan Anemia during pregnancy and breast feeding is 37%. 23%-24% have mild anemia , 13.5% have moderate ,1% have

sever anaemia. Degree: Mild: 8-10gm%Degree: Mild: 8-10gm%

Moderate: 7-8gm% Moderate: 7-8gm% Severe: <7gm% Severe: <7gm%

According to UNICEF its found that more than 28% of women of child bearing age were anaemic in Jordan.

Causes and predisposing factors:1- low iron intake low intake of iron-rich food nausea and vomiting 2- Increased demand heavy mens High parity bleeding haemorrhoids3- Inadequate absorption /utilization of iron food that have a strong inhibiting effect on iron absorption , tea ,

coffee, egg, ca++ rich foods. Malabsorption syndrome. Decreased HCL.

4- increased iron requirements: Increased demand from growing fetus , placenta. Low internal between 1st and 2nd pregnancy Effects of anemia on pregnancy : Maternal : abruptio placenta may be associated with maternal anaemia. high risk for PPH. High risk for infection puerperal sepsis. Poor lactation is often a consequence of anaemia. High risk of developing shock and death if Hge occur during

child birth (potential threat to life) . Reduced enjoyment of pregnancy and mother hood of to

fatigue.

Fetal :

- increased of still birth neonatal deaths if maternal Hb% decreased 8%.

-Increased incidence of pre-term labour.

-increased incidence of IUGR and hypoxia

** Note : the most common forms of anemia are caused by deficiencies in iron and folic acid.

Nurse role in the assessment of women with anemia in pregnancy

History taking: hx of any of the predisposing factors.

symptoms of anemia : C.V.S palpitation. C.N.S headache , visual disturbance , weakness ,

fatigability , drowsiness. R.S breathlessness. G.I.S anorexia , nausea , vomiting. G.U.S loss of libido.

Conjunctival PallorConjunctival Pallor

Physical exam : General exam pallor of the skin and mucous of

membrane , tachycardia, tiredness. Abdominal exam fundal height : less than the

gestational age Investigations : Laboratory investigation CBC and RBC HB < 10.5 gm/dl. RBC concentration < 5x10^6 /mm^3 hypochromic & microcytic.

Normal Iron Requirements

Iron requirement for normal pregnancy is 1gm

200 mg is excreted300 mg is transferred to fetus500 mg is need for mother

Total volume of RBC inc is 450 ml

1 ml of RBCs contains 1.1 mg of iron450 ml X 1.1 mg/ml = 500 mg

Daily average is 6-7 mg/day

Blood film. Reticulocytic count. Serous ferritin level. Ultrasound to check gestational age ,

placental site , amount of liqour & any congenital fetal malformation.

Normal hemoglobin by gestational age in Normal hemoglobin by gestational age in pregnant women taking iron supplementpregnant women taking iron supplement

12 wks12 wks 12.2 [11.0-13.4]12.2 [11.0-13.4] 24wks24wks 11.6 [10.6-12.8]11.6 [10.6-12.8] 40 wks40 wks 12.6 [11.2-13.6]12.6 [11.2-13.6]

Intervention in pregnant women with anemia

Prophylactic Importance of antenatal visits Encourage to attend the scheduled antenatal visit and explain

the importance of preventing & treating anemia in pregnancy. Educate the mother regarding the sources of food rich in iron &

folic acid , sea food , fruit , meat, egg , green vegetables. Advice to avoid poor eating habits & intake of enhancers of iron

absorption such as fruit , vegetables , vit C Iron supplementation is very important during pregnancy & it

should be emphasized on all antenatal visits.

TreatmentTreatment

Prophylactic: Supplement Fe – 60 mg: Supplement Fe – 60 mg elemental Fe with Folic elemental Fe with Folic AcidAcid

CurativeCurative: 200mg FeSo4 3 times daily till : 200mg FeSo4 3 times daily till Hb level becomes normal, then Hb level becomes normal, then maintenance dose of 1 tab for maintenance dose of 1 tab for 100 days 100 days

WHO recommended for iron supplementation for any pregnant women :

All pregnant women should be given the standard dose of iron or folate (tab of 30 mg iron + 400 mg folic acid/day ) every day for women with normal iron stores for 6 months during pregnancy and continuing post partum

Avoid iron supplement during 1st trimester and give after nausea subsided.

Curative and management of anemia

Oral supplementation ferrous sulphate Parenteral iron therapy.1. When diagnosed late in pregnancy 2. Malabsorption 3. Gastric intolerance to oral iron Blood transfusion During blood transfusion :monitor uterine activity ,

FM , FHR Plus routine observation

Natal and post natal care:

Assess the Hb prior to delivery Give blood if Hb% decreased 10.5 mg/dl. Prevent infection. Insure adequate hydration. Practice an active management of 3rd stage.

of labour advise to seek contraception.

Sickle cell anemia

An inherited disorder caused by abnormal Hb% in the blood (abnormal shape) lead to hypoxia , dehydration ,infection , fatigue crisis

Effect on the pregnancy : Effect on the organs and placenta blockage of

vessels & infarcts in organs , blockage to the placenta , circulation occurs lead to fetal death & increase risk for abortion.

Management

Blood transfusion to maintain hematocrit increased 30%.

Management during labour O2 supplement I.V fluid fetal monitoring antibiotic if C/S birth

Effects on pregnancyEffects on pregnancy

Increase incidence of abortion, prematurity, Increase incidence of abortion, prematurity, IUGR and Fetal loss.IUGR and Fetal loss.

Perinatal mortality is high.Perinatal mortality is high. Incidence of pre-eclampsia, postpartum Incidence of pre-eclampsia, postpartum

hemorrhage and infection is increased.hemorrhage and infection is increased.

Thalasemia

Abnormal Hb haemolysis Risk for infection. Avoid iron accumulation by using

chelating factor. Monitor fetal and maternal condition.

Folic acid deficiency anemia (megaloplastic anemia)

Folic acid is needed for increased cell growth of both mother and fetus (necessary in all body cells synthesis DNA)

Occurs as a result of inadequate intake , poor absorption , increased use & poor cooking habits.

Decreased folic associated with decreased B12 vit Decreased folic acid associated with decreased iron mainly Occurs in the last trimester due to increased demand &

decreased intake

Pernicious anemia (vit B12 deficiency)

In adequate intake vegetarian Common in elderly person & females