ANEMIA IN PREGNANCY

1. ANEMIA IN PREGNANCY
By: Ms. Nikita Saliya

2. ANEMIA IN PREGNANCY:-
• Anemia is the most common haematological disorder that
may occur in pregnancy.
• Anemia = Lack of blood

3. Causes of
anemia
Before
pregnancy
During
pregnancy

4. Causes of anemia: Before Pregnancy
Faulty dietetic
habit
Faulty
absorption
mechanism
Iron loss:-
more iron is
lost through
sweat
Repeated
pregnancies
at short
intervals
Excessive
blood loss
during
menstruation
which is
untreated
often.

5. Causes of anemia: During Pregnancy
Increased demands of iron
Diminished intake of iron
Diminished absorption
Disturbed metabolism-presence of infection markedly interferes with
erythropoiesis.

6. Pre-pregnant health status
Excess demand:-Multiple pregnancy increases the iron demand by two-fold
Women with rapidly recurring pregnancy, within 2yrs following the last
delivery, need more iron to replenish deficient iron reserve.
Women with heavy menstrual bleeding (HMB)are often anaemic. (fibroid
uterus is most common cause of HMB)
Anemia due to underlying diseases(UTI).

7. Classifi-
cation
Iron
deficiency
Folic acid
deficiency
Vitamin
B12
deficiency

8. 1.IRON DEFECIENCY ANEMIA:-
• Clinical Features:-
Fatigue or weakness may be the earliest manifestation
Anorexia and indigestion
Palpitation
Dyspnoea etc.

9. Anemia
Mild:
10.0 to
10.9gm/dl
Moderate:
7-9.9gm/dl
Severe:
<7gm/dl

10. Complications of anemia in pregnancy:
During
pregnancy
Pre-eclampsia may be related
to malnutrition & hypo-
proteinemia.
Recurrent infection.
Preterm labor.
Heart failure at 30 to 32
weeks of pregnancy
During
labour
Uterine inertia
Postpartum hemorrhage
Cardiac failure
Shock

11. Effects on baby:
• There is increased incidence of low birth weight babies with its
incidental hazards.
• Intrauterine death-due to severe maternal anaemia.
• Anemia in infancy due to reduced iron store.

12.  Treatment:-
• Prophylactic :
Avoidance of frequent childbirths
A minimum interval should be at least 2 year , to replenish
the lost iron during childbirth process & lactation.
Supplementary iron therapy
Dietary prescription:- The foods rich in iron are liver,
meat, egg, green vegetables, green peas, beans, whole
wheat, jaggery & etc.

13. • Adequate treatment should be instituted to eradicate
hookworm infestation, dysentery, malaria, bleeding
piles & urinary tract infection.
• Curative:- Anemia is not a disease but a sign of an
underlying disorder. Treatment must be preceded by an
accurate diagnosis of the cause of anemia & type of
anemia.

14. • General treatment:-
• Diet: A realistic balanced diet rich in proteins, iron
& vitamins .
• To improve the appetite & facilitate digestion,
preparation containing acid pepsin may be given
thrice daily after meals.
• To eradicate even a minimal septic focus by
appropriate antibiotic therapy
• Oral and parenteral(IV/IM) iron therapy

15. MANAGEMENT DURING LABOR:-
• FIRST STAGE:- Patient should be in bed and lie in a position
comfortable to her.
• Oxygen therapy with nasal cannula ma be given.
• Strict asepsis is to be maintained throughout labor to minimize
puerperal infection.
• SECOND STAGE:-Prophylactic low forceps or vacuum delivery
ma be done to shorten the duration of second stage.
• Injection oxytocin 10 IU IM should be given soon following
delivery of the baby

16. THIRD STAGE:-
• Significant amount of blood loss should be replenished by
fresh packed cell transfusion after taking the usual
precautions mentioned earlier.
• The danger of postpartum overloading of the heart should be
avoided.

17. 2) MEGALOBLASTIC ANEMIA:-
• Causes of folic acid deficiency in pregnancy are:
Inadequet intake
Increased demand
Diminished
absorption
Failure of
utilization
Diminished
storage

18. Inadequent intake due to:- nausea/voming &lack of appetite.
Increased demand due to:-increased maternal tissue
including red cell volume, growing fetus & multiple
pregnancy.
Diminished absorption:-Intesnal malabsorption sndrome is
responsible for its recurrence in subsequent pregnancies.
Failuree of utilization :-this is associated wih anticonvulsant
drugs used in epilepsy or with presence of infection.
Diminished storage:-this is associaed with hepatic
disorders,hyperhomocysteinemia &vitamin C deficiency.

19.  Prophylactic Therapy:-
• All women of reproductive age should be given 400mg of folic
acid daily.
• Additional amount (4mg) should be given in situations where the
demand is high.
• Such condition are:-multiple pregnancy, patient having
anticonvulsant therapy etc.
• Women having previous infant with neural tube defects, should
be given 4mg of folic acid daily beginning 1 month before
conception to about 12 weeks of pregnancy.

20. Curative:-
• SPECIFIC THERAPY INCLUDES:-daily administration of
folic acid 4mg orally which should be continued for at least
4 weeks following delivery.
• Supplementation of 1mg of folic acid daily along with iron
& nutritious diet can improve pregnancy-induced
megaloblastic anemia by 7-10days.

21. • Folic acid should never be given without supplemental iron.
• Supplementary intramuscular vitamin B12 100mg daily or on
alternate days may be added when response to folic acid alone
is not adequate.
• Ascorbic acid 100mg tablet thrice daily enhances the action of
folic acid by converting i into folinic acid.

22. Thank you…