For medical students

1. ANAEMIA IN
PREGNANCY

2.  Anaemia in pregnancy is a condition in
which the haemoglobin level in a pregnant
woman is less than 10 g/dl. Anaemia is
graded as:
 Mild: Hb is between 8–9.9 g/dl.
 Moderate: Hb is between 6–7.9 g/dl.
 Severe: Hb is below 6 g/dl.

3. In most cases, the diagnosis is based on the
following clinical findings:
 Feeling of tiredness, weakness, dizziness
 Pallor of mucous membranes or
conjunctivae, gums, tongue and palms of
hands
 Pallor of nail beds characterised by poor
venous return.
 Swelling of the legs (pitting)

4. Differential Diagnosis
 Nephrotic syndrome may present with
swelling of the face and legs and pallor of
mucous membranes
 Cardiac disease
 Hypertension

5. Investigations
These can be carried out where facilities are
available:
 Hb estimation at first contact with every pregnant
woman
 Full haemogram
 Another Hb estimated at 36–38 weeks
 Other investigations (e.g., blood film malarial
parasites, sickle cell tests, reticulocyte count,
stool for microscopy and occult blood, urine
analysis) are usually carried out in establishing a
diagnosis.

6. Immediate management
If a patient has severe anaemia or is in cardiac failure due to
anaemia, refer to hospital. During transfer:
 Rest in propped position.
 Give oxygen by face mask and provide supportive care.
 Accompany patient by a health worker.
 Provide reassurance. In hospital:
In hospital
 Provide resuscitation tray.
 Transfuse (with packed cells, if possible) under cover of a
rapidly acting diuretic (e.g., Frusemide, 20 mg IV).