Anaemia in Pregnancy
the reduction in the Oxygen carryingcapacity of the blood. It is the reduction
in the quantity and quality of the red blood cells and haemoglobin levels.
It is a condition in pregnancy
inwhich the hemoglobin level is less than 11g/dl and packed cell volume is less
than 33%. Anaemia in pregnancy is a common cause of maternal mortality
2 types of anaemia in pregnancy Physiological
pregnancy, the maternal blood ties to compensate for the blood being used by
the fetus from the mother thereby causing increase plasma volume of the
maternal blood which gradually increases by 50%. This usually occurs in the
there is increase in red blood cells towards the later part of pregnancy to
about 25%. This results in haemodilution (which is an increase of plasma in the
blood in proportion to the cells) which causes fall in haemoglobin
concentration. These physiological changes are not pathological but are
necessary for the development of the foetus in pregnancy.
pregnancy, approximately 1500mg of iron is needed
increase in maternal hemoglobin (400-500mg) the fetus and placenta (300-400gm)
replacement of daily loss through stools, urine and skin (250mg) replacement of
blood loss at delivery (200mg). About 95% of pregnant women with anaemia have
the iron deficiency type.
Reduced intake or absorption of iron as a result of
iron deficiency in diet and gastro – intestinal disturba nces (as in morning
Withdrawal of iron by fetus
Folic acid deficiency resulting from haemolysis,
malaria , hemoglobinpathy, inadequate intake ,malabsorption of folic acid
Excess demand due to multiple pregnancy,
multiparty, chronic inflammation especially urinary tract infection.
Hemorrhage, antepartum or post partum hemorrhage,
(always tired) Fainting, Dyspnoea, Tachycardia and palpitations
resistance to infection – Puerperal sepsis Potential threat to life.
risk of abortion
risk of intrauterine hypoxia and growth retardation Preterm birth, Low birth
risk of perinatal morbidity and mortality
Good ante-natal care
Intake of diet rich in iron, diet rich in protein,
minerals and vitamins
Reduce workload and stress. Encourage rest
Early recognition and treatment for anaemia .
Ferrous sulphate – 200mg tab b.d
Ferrous gluconate - 300mg tab 1.e 2 tab b.d
Blood transfusion might be given to treat severe
Treatment for worm if present.
It is a
type of anaemia in pregnancy which there is a physiological disease in serum
folate levels which occurs towards the end of pregnancy.
Reduced dietary intake
Interference with utilization e.g. drugs like anti
Excessive demand and loss as in multiple pregnancy
cell volume, Full blood count
weight loss, depression, nausea and vomiting, glossitis, gingivitis, diarrhoea.
Folic acid therapy: 5mg orally daily
Encourage diet rich in folic acid e.g. green
vegetable, bananas, citrus fruits, pears, peanuts.
Ensure adequate rest.
cell disorders are found most commonly in people of African or west Indian
condition defective gene produce abnormal haemoglobin beta chains: the
resulting Hb is Hb SS.
Sickle Cell Anaemia: Sickle cells
have an increased fragility andshortened life span of 17 days resulting in
chronic haemolytic anaemia and causing episodes of ischaemia and pain; these
are known as sickle cell crisis. Women with sickle cell anaemia may be
subfertile but those who do become pregnant may already have organ damages.
stress, cold climate, extreme temperature changes, smoking , induced hypoxia,
strenuous physical exercise, fatigue, respiratory disease and pregnancy.
Anaemia, fatigue, joints pain, epigastric pain, vomiting, abdominal tension,
splenomegally, hepatomegally, pyrexia.
Risk of early abortion
Intra uterine death
Risk of embolism
Refer to bigger hospital with better equipments for
Regular monitoring of haemoglobin level
Blood transfusion every 6 weeks if necessary.
Advise woman to avoid situation that will
precipitate a crisis.
If crisis occurs, admit patient, rehydrate, treat
infection, relief pain, give oxygen therapy and blood transfusion.