7a anemia and other common problems 13-sept 2011

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7a anemia and other common problems 13-sept 2011

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7a anemia and other common problems 13-sept 2011

  1. 1. 1Anaemia during Pregnancy andin the Postpartum periodMaternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 7 (a)Session 7a
  2. 2. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Session Objectives To be able to:• Diagnose Anaemia & Malaria• Treat Anaemia & Malaria• Prevent Anaemia & Malaria Refer cases of Severe Anaemia to FRU
  3. 3. 3Anaemia
  4. 4. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4Anaemia in PregnancyDefinition Anaemia is defined as Hb level < 11gm% inpregnancy or immediate post partum period. Anaemia is grouped as (ICMR Classification)• Mild (10-11gm %)• Moderate (7-9.9 gm %)• Severe (4 – 6.9gm %)• Very severe (<4 gm %)
  5. 5. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5Diagnosis of anaemia and its severitySymptoms & signs Probable Diagnosis (ICMRClassification)Haemoglobin >11 g/dlNo pallorNo clinical AnaemiaHemoglobin 10-10.9 g/dl Mild AnaemiaHaemoglobin 7-9.9g/dlORPalmar or conjunctival pallorModerate AnaemiaHaemoglobin 4-6.9 g/dlAND/ ORSevere palmar and conjunctival pallor or anypallor with any of the following:* >30 breaths/minute* Easy fatiguability* Breathlessness at restSevere AnaemiaHaemoglobin <4 g/dlAND/ OR as severe anemiaVery Severe Anaemia
  6. 6. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6Management Depends on :• Severity of anaemia• Gestational age Iron administered either orally or parentallyrequires a minimum period of 4 - 6 wks to raisethe Hb to normal levels Nutritional counselling for iron rich food(likejaggery, spinach etc)
  7. 7. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Management For prophylaxis: 1 IFA tablet (with 100 mg elemental iron and 0.5 mgfolic acid) once daily for 100 days starting after the 1st trimester. Mild to Moderate anemia :• IFA tabs (100 mg elemental iron + 0.5 mg folic acid) twice dailyand to be continued during postpartum period.• Administer parenteral iron preparation if there is non compliance /intolerance to oral iron. Moderate and Severe anaemia: May receive antihelminthic drugs(Tab. Mebendazole 100 mg bd for 3 days or Tab. Albendazole 400 mgsingle dose) especially in hookworm endemic areas during 2nd/3rdtrimesters of pregnancy. Severe anemia :• Refer to FRU for further investigations & treatment.• This woman might need a blood transfusion.
  8. 8. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Management- Mild & Moderate Anaemia Give IFA tablet (with 100 mg elemental iron and 0.5 mg folicacid) twice daily for 100 days & to be continued in post partumperiod for 3 months. Counsel the woman on the need for compliance with treatment. Nutritional Counselling for Iron Rich Food• Administer parenteral iron preparation if there is noncompliance / intolerance to oral iron. Give LLINs if you are in a malaria-endemic zone. Give the woman an antihelminthic for deworming (Tab.Mebendazole 500 mg stat , or Albendazole 400 mg stat),especially if you are in a hookworm-endemic area.
  9. 9. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Management – Mild & Moderate anaemia Reassess after one month. If Hb level increases continue treatment If no improvement refer to FRU for further management If the woman of mild & moderate anemia reports inlabour• Conduct the delivery with emphasis on AMTSL• Monitor her for 48 hours• Check Hb level after 3 days• Prescribe I tab (100 mg) of IFA twice daily for 6months post partum• Reassess her in the next postnatal visit at 6 weeks &refer to FRU if no improvement
  10. 10. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Management – Severe anaemia Should ideally be managed in a CEmOC facility whereblood transfusion facility is available Refer her to FRU at the earliest If she reports in first stage of labor and there issufficient time or post partum refer her to FRU If she reports in active labor with delivery imminent,• Conduct the delivery with minimal possible bloodloss (AMTSL)• Monitor the vital signs intensively during the delivery• Refer urgently to FRU after stabilizing her condition Follow up the woman in two weeks to check the clinicalprogress, test results and compliance with treatment ofdouble dose of iron (1 tablet twice a day) for 6 monthspostpartum.
  11. 11. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11
  12. 12. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12
  13. 13. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Counselling – Diet & Rest Reassure the mother that she can eat normal food ; these will notharm the breast fed baby Diet to be rich in iron & fibre Discuss about food taboos especially against food that arenutritionally healthy Talk to family members like mother in law , husband to encouragethem to ensure that the woman easts enough & avoids heavyphysical work Take care of the mother so that she can take care of the baby Counselling on diet especially for adolescent mother IFA Supplementation Women with normal Hb are advised to take 1 IFA tablet daily for 3months If Hb below 11 gm%, advise her to take 2 IFA tabs daily and repeatHb after 1 month Family support specially for girl child Rest to the Mother
  14. 14. 15Malaria
  15. 15. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16Screening and prophylaxis of malaria duringpregnancy No prophylaxis is recommended butinsecticide treated bed nets/LLIN be given onpriority basis to the all pregnant women invulnerable population High malaria endemic areas: Routine testing& screening for malaria on the 1st ANC & ineach month by RDK tests even if she does notmanifest any malaria symptoms Non endemic areas: All clinical suspectedcases (as per NVBDCP guidelines) shouldpreferably be investigated for malaria by RDK
  16. 16. 17Treatment in 1stTrimester
  17. 17. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Treatment: Uncomplicated MalariaP. vivaxChloroquine base to begiven as under:Day 1 4 tabs @10mg/kgDay 2 4 tabs @10mg/kgDay 3 2 tabs@5 mg/kgP. falciparumQuinine (as tablets) 10mg. quinine salt/kg. bodyweight 3 times daily for 7days.
  18. 18. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Treatment: Severe and complicated malaria Parenteral Quinine is the drug of choice in first trimester Loading dose :• 20 mg/kg. body weight on admission (I.V. infusion in 5% Dextrose/dextrose saline over a period of 4 hours)• May not be given if the patient has already received quinine or if clinicianfeels inappropriate. Maintenance dose:• 10 mg./kg. bw 8 hourly• infusion rate should not exceed 5 mg salt/kg bw per hour NEVER give bolus injection of Quinine Parenteral Quinine given for minimum of 48 hours & once the patienttolerates oral therapy, follow-up treatment is as under:• Quinine 10 mg./kg. bw three times a day to complete a course of 7 daysPLUS• Clindamycin 10mg./kg. bw 12 hrly should be given for 7 days If Parenteral Quinine to be given after 48 hours, reduce dose to 7 mg/kgbody weight 8 hourly. Parenteral Treatment should be given for a minimum of 24 hours oncestarted If Quinine unavailable, artemisin derivatives may be used
  19. 19. 20Treatment of Malaria in2nd& 3rdTrimesters
  20. 20. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India21TREATMENT:P. vivaxChloroquine base to begiven as under:Day 1 4 tabs @10mg/kgDay 2 4 tabs @10mg/kgDay 3 2 tabs@5 mg/kgP. falciparumACT to be given asunder:1stday2ndday3rddayAS 4 tabs 4 tabs 4 tabsSP 3 tabs Nil NilAS- artesunate 50 mgSP-Sulfadoxine 500 mg +Pyrimethamine 25 mg
  21. 21. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India22Treatment: Severe and complicated malaria Parenteral artemisin derivatives preferred in 2nd& 3rdtrimesters. To be given as under:• Artesunate 2.4 mg/kg bw iv or im given on admission then at 12hours & 24 hours, then once a day Care should be taken to dilute artesunate powder in 5%Sodium bicarbonate provided in the pack• Artemether 3.2 mg/kg body weight im given on admission then 1.6mg/kg bw per day• Α-βArteether 150 mg daily im for 3 days
  22. 22. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India23Side effects of Quinine Metallic taste Nausea Tinnitus HypoglycaemiaNote: Pregnant women should not take quinine on anempty stomach and should eat regularly, while onquinine treatment No special diet is needed Primaquine is contraindicated during pregnancy.
  23. 23. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India24Key Messages Prophylaxis of anaemia Management of Anaemia Management of Complicated andUncomplicated Anaemia in First, Second &Third Trimesters Referral of Severe Anaemia Cases
  24. 24. ANAEMIA DURING PREGNANCY AND IN THE POSTPARTUM PERIODMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India25Case Studies Case Study Number 23 on page number 88 &89 of Trainees Hands Book
  25. 25. 26Thank you

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