Obgyn Anemia in Pregnancy for UG Class

8/17/2019 Obgyn Anemia in Pregnancy for UG Class

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Anemia in Pregnancy

Prof. Vinita Das

HOD Ob/Gyn

KGMU Lucknow


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Learning Obecti!es

Diagnose anemia in "regnancy

Learn t#e effect on mot#er $ fetus

Learn %/% in "regnancy

Learn "re!ention of anemia

Learn su""&ementation of ora& iron 'uring "regnancy

Management of anemia 'uring "regnancy

Labor $ De&i!ery management

(ationa& anemia contro& "rogram

Post "artum contrace"tion


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)ackgroun' *nformation

+ommonest me'ica& 'isor'er in "regnancy

Pre!a&ence in *n'ia !aries between ,--0

Pre!a&ence in U%A is 120

(utritiona& anemia 34e 'eficiency5 is commonest

*t is im"ortant contributor to materna& $ "erinata&

morbi'ity $ morta&ity as a 'irect or in'irect cause


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Definition Anemia

A con'ition w#ere circu&ating &e!e&s of Hb are6uantitati!e&y or 6ua&itati!e&y &ower t#an norma&

(on "regnant women Hb 7 81gm0

Pregnant women 39HO5 Hb 7 88 gm0

Haematocrit 7 ::0Pregnant women 3+D+5 Hb 788 gm0

8st$:r' ;rimester

1n' trimester Hb 7 8-., gm0


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*+M< Anemia %e!erity +&assification

Hb !a&ues

Mi&' 8-.-8-.= gm0

Mo'erate =.=

%e!ere 7

Very %e!ere 72


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+auses of Anemia in Pregnancy

(utritiona& / *ron 'eficiency anemia

Pre"regnancy "oor nutrition !ery im"ortant

)esi'es *ron> fo&ate an' )81 'eficiency a&so im"ortant

+#ronic b&oo' &oss 'ue to "arasitic infections ? Hookworm $ ma&aria

Mu&ti"arity

Mu&ti"&e "regnancy

Acute b&oo' &oss in APH> PPH

sick&e ce&& anemia

A"&astic anemia is rare


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Pat#o"#ysio&ogy of (utritiona& Anemia in

Pregnancy

Augmente' eryt#ro"oiesis in "regnancy

)&oo' !o&ume increases 2-2,0 in "regnancy

*ncrease in "&asma is more as com"are' to re' ce&& mass&ea'ing to #emo'i&ution $ 'ecrease in Hb &e!e&

*ron stores are 'e"&ete' wit# eac# "regnancy

;oo soon $ too many "regnancies resu&t in #ig#er"re!a&ence of iron 'eficiency anemia


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@tra *ron


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4actors stimu&ates stemce&&s in )one Marrow5> ;#yroine> An'rogens

;race e&ements ? Binc 3a&so im"ortant for "rotein synt#esis $(uc&eic aci' metabo&ism5> +oba&t> +o""er

Vitamins ? Vit )81 re6uire' for synt#esis of

4o&ic aci' 3Vitamin =5 re6uire' in &ater stage for D(A synt#esis

Vitamin + necessary for con!ersion of fo&ic aci' to fo&inic aci'> iten#ances absor"tion of iron from sma&& intestine

Pyro'oine )C usefu& a'u!ant in eryt#ro"oeisis

Vitamin A re6uire' for ce&& growt#> 'ifferentiation $ maintenance ofintegrity of e"it#e&ium> immune function


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P#armacokinetics of *ron / 'ai&y re6uirement

(orma& 'iet contain about 82mg of iron

Absor"tion of iron is ,8-0 381 mg5 $ :20 in "ure !eg 'iet

A''itiona& 'ai&y iron 'eman' inear&y "regnancy 1: mg/'ay

*n &ate "regnancy C mg/'ay

%o 'ai&y su""&ement of 2-C-mg of e&ementa& iron isre6uire' 'uring "regnancy

4o&ic aci' re6uirement is a&soincrease' 2--C-- ug/'ay

*n strict !eg Vit ) 81 is a&so'eficient


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+&inica& Presentation

De"en's on se!erity of anemiaHig# risk women ? a'o&escent> mu&ti"arous> mu&ti"&e"regnancy> &ower socio economic status

Mi&' anemic asym"tomatic

%ym"toms ? "a&&or> weakness> fatigue> 'ys"noea>"a&"itation> swe&&ing o!er feet $ bo'y

%igns ? "a&&or> facia& "uffiness> raise' VP> tac#ycar'ia>tac#y"nea> cre"ts in &ung bases> #e"atos"&enomega&y>"itting oe'ema o!er ab'omina& wa&& $ &egs

Haemic murmur> car'iac fai&ureG&ossitis> stomatitis> c#e&osis> britt&e #air


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@ffect of Anemia on Pregnancy $ Mot#er

Hig#er inci'ence of "regnancy com"&icationsP@;> abru"tio "&acentae> "reterm &abor

Pre'is"ose' to infections &ike ? U;*> "uer"era& se"sis

*ncrease' risk to PPH

%ubin!o&ution of uterus

Lactation fai&ure

Materna& morta&ity ? 'ue to +H4>

+erebra& anoia>

%e"sis>

;#romboembo&ism


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@ffect of Anemia on 4etus $ (eonate

Hig#er inci'ence of abortions> "reterm birt#> *UG<

*UD

Low APGA< at birt#

(eonate more susce"tib&e for anemia $ infectionsHig#er Perinata& morbi'ity $ morta&ity

Anemic infant wit# cogniti!e $ affecti!e 'ysfunction


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Most +ritica& Perio'

1E:- weeks of "regnancy

*n &abor

*mme'iate&y after 'e&i!ery

@ar&y Puer"erium

+H4

34ai&ure to co"e u" wit# "regnancy in'uce'

car'iac &oa'5


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9ork U" of Pregnancy wit# Anemia

Detai&e' H/o ? age> "arity> 'iet> c#ronic b&ee'ing>worm infestation> ma&aria> race etc

@aminationPa&&or

G&ossitis

%"&enomega&y ? #emo&ytic anemia

aun'ice ? #emo&ytic anemia

Pur"ura ? b&ee'ing 'isor'er

@!i'ence of c#ronic 'isease ? ;)

Anasarca $ signs of car'iac fai&ure in se!ere cases


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*n!estigation

%e!erity of anemia ? Hb $ Haematocrit> at first !isit> 1E:-weeks $ :C weeks

;y"e of anemia ? G)P microcytic> macrocytic> 'imor"#ic>normocytic> #emo&ytic> "ancyto"enia

)one marrow acti!ity ? reticu&ocyte count 3( .1105>#ig#er bone marrow acti!ity is seen in #emo&ytic anemia

fo&&owing acute b&oo' &oss

iron 'ef anemia on treatment+ause of anemia ? by !arious in!estigations


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G)P %taine' wit# Leis#man stain

(orma& smear ? (ormocytic 3(orma&

siFe normoc#romic 3(orma&

co&our


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microcytic

M+H 'ecreasesM+H+ ? 'ecreases> one of t#e most sensiti!e in'ices

3(1C:-05


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%"ecia& *n!estigations

%erum 4erritin ? abnorma& if 7 1- ng/m& 3( 2-8C- ng/'&5>

assess iron stores

%erum *ron ? ( C,8C, ug/'&> 'ecreases in 4e 'ef

anemia

%erum *ron bin'ing ca"acity ? :--:C- ug/'&> increases

wit# se!erity of anemia

Percentage saturation of transferrin ? :,,-0>

'ecreases to &ess t#an 1-0 in fe 'ef anemia


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Differentiation between iron 'eficiency anemia $ ;#a&assemia

='iminis#e' synt#esis of Hb b c#ains in ;#a&assemia5

*n!estigations (orma& !a&ues 4e Def Anemia ;#a&assemiaM+V ,=C f& re'uce' V re'uce'

M+H 1::"g re'uce' V re'uce'

M+H+ :1:, gm/'& re'uce' ( or re'uce'Hb4 71 0 norma&


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Ot#er *n!estigations

Urine eamination ?


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;reatment for *ron Deficiency Anemia

*m"ro!ing 'iet ric# in iron $fruits $ &eafy !egetab&es

;reat worm infections>maintain genera& #ygiene

4oo' fortification wit# iron $

genetic mo'ification of foo' *ron $ fo&ic aci'

su""&ementation in young gir&s$ 'uring "regnancy

Heme iron better> "resent inanima& foo' $ is betterabsorbe'

*ron absor"tion en#ance' bycitrous fruits> Vit +

A!oi' tea> coffee> +a>"#ytates> "#os"#ates>oa&ates> egg> cerea&s wit# iron


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*ron


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*ron su""&ementation in Pregnancy

C- mg e&ementa& iron $ 2-- ug offo&ic aci' 'ai&y 'uring "regnancyan' : mont#s t#ere after

*n anemia t#era"eutic 'oses are8E-1-- mg /'

g&uconate> succinate> su&fate>ascorbate

+arbony& iron better to&erate' Ora& iron can #a!e si'e effects &ike

nausea> !omiting> gastritis>'iarr#oea> consti"ation

*ron su""&ementation not

recommen'e' in first

trimester Hig#er inci'ence of

miscarriage )irt# 'efects

)acteria& infection 3bacteria

grow after taking iron from

su""&ementation5


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Ora& *ron

Hb E88 gm0> ear&y "reg

+ontrain'ication to Ora& *ron;#era"y *nto&erance to ora& iron

%e!ere anemia in a'!ance'"regnancy

(on com"&iant

4ai&ure to


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Parentera& *ron ;ransfusion

*ron sucrose for "arentera& use

Dose ca&cu&ate' 9t in Kg

iron 'eficit 1.1 I 8--- mg for

iron stores


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*n'ications for )&oo' ;ransfusion

%e!ere anemia first seen after

:C weeks of "regnancy

Anemia 'ue to acute b&oo'

Loss ? APH $ PPH

Associate' *nfection

Patient not res"on'ing to ora&

or "arentera& t#era"y

Anemic $ sym"tomatic

"regnant women 3'ys"neic>

wit# #eart fai&ure etc5irres"ecti!e of gestationa& age


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Management of Labor

Labor s#ou&' be su"er!ise'Pro"er counse&ing $ consent to be taken

)&oo' 3w#o&e $ "acke'5 ke"t cross matc#e'

9omen nurse' in "ro""e' u" "osition

*ntermittent O1 to be gi!enPrecaution to "re!ent infection $ b&oo' &oss

%trict ase"tic "recautions $ minima& P/V eams

Pro"#y&actic antibiotic can be gi!en

Patent i! &ine but f&ui's are a!oi'e' *n 'ecom"ensate' "atient 'iuretic gi!en


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%econ' $ ;#ir' %tage of Labor

%econ' stage cut s#ort by force"s or !entouse

Acti!e management of :r' stage of &abour to be 'one

Oytocics> P/< miso"rosto& can be gi!en after 'e&i!ery of

fetus *nection met#ergin i! contrain'icate'

@!en norma& b&oo' &oss may be to&erate' "oor&y in

anemic "atient

*V 4rusemi'e gi!en after 'e&i!ery to 'ecrease car'iac&oa'


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Pregnant woman is consi'ere' anemic w#en #er Hb is

be&ow 3unit gm/'&5

A. 81

). 88

+. 8-D. =


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Most common cause of anemia in "regnancy in

*n'ia is

A. (utritiona& anemia

). Parasitic anemia

+. A"&astic anemiaD. ;#a&assemia


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*ron 'eficiency anemia can be 'iagnose' ear&iest

by w#ic# &aboratory test

A. Hb0

). %erum ferritin

+. %erum ironD.


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9#ic# com"&ication is not common in Pregnancy

wit# anemia

A. P*H

). Preterm &abour

+. GDMD. Puer"era& se"sis

Obgyn Anemia in Pregnancy for UG Class

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