This document discusses anaemia in pregnancy, defining it as hemoglobin levels below 11 g/dL in the first trimester, 10.5 in the second and third trimesters, and 10 immediately postpartum. It describes the main causes of anaemia in pregnancy as haemodilution and increased iron requirements for fetal growth. Management depends on severity, cause, and gestational age, and may include oral or intravenous iron supplementation, blood transfusions, or treating underlying causes like malaria. The complications of anaemia in pregnancy include increased risks of maternal and fetal morbidity and mortality.

1. ANAEMIA IN
PREGNANCY
BY DR. NGWIRA

2. ANAEMIA IN PREGNANCY
DEFINITION
 Hb < 11 g/d1 in 1st trimester, < 10.5 in 2nd 3rd and <10 immediately
postpartum.
 WHO- lower limit should be 2 SD below the normal population
GRADES
 Mild <11 – 9
 Moderate 8.9- 7
 Severe < 7
2

3. TYPES AND CAUSES
 Commonest type is Iron deficiency anaemia due to:
 Haemodilution – Physiological Anaemia due to disproportionate
increase in plasma volume (30%-40%) Vs. Red cell volume
increase (25%).
o May not be apparent in pre-eclampsia
 Iron utilisation increases as is required for fetal growth and
development as well as maternal erythropoiesis.
o Demand worsens as pregnancy advances. (2nd and 3rd term)
o requirement per day in 1st trimester is 3-4mg/day and 6-7
mg/day in 2nd
o Demand more in multiple pregnancies
3

4.  Nutritional
 Infestations (E.g. Hookworm)
 Previous pregnancies – multipara, miscarriages
 Menstrual disorders - menorrhagia.
 GIT bleeding
OTHER CAUSES
 Hemoglobinopathies – HBS, thalassemias
 Hemolysis – Malaria, SCD
 Hemorrhage- APH
 Chronic illness – TB, HIV
 Poor diet
 Malabsorption
 Drugs- Anticonvulsants, ARVs.
4

5. Complications
 Increased maternal and Foetal morbidity and mortality.
 Maternal:
■ Cardiac failure
■ Sepsis (infections)
■ Unable to withstand even minor acute blood loss.
■ PPH
■ Increased risk of maternal mortality ( Hb< 7)
o Foetal :
■ Hypoxia
■ Preterm labour
■ IUFD
■ Low birth weight
5

6. Diagnosis
 History.
o Dyspnoea (breathlessness)
o Weakness, fatigue.
o Headache.
o Palpitations.
o Pica
o Others due to the cause:
■ Malaria – fever
■ Bleeding in pregnancy.
 Examination
■ Pallor/ jaundice/ petechiae
■ Tachycardia.
■ Dyspnoea.
■ Organomegaly 6

7. Diagnosis
 Investigation.
o Aim to establish :
• Severity
• Type
• Cause.
o Severity.
• Hb- mild, moderate, severe
7

8. Diagnosis cont…
o Type.
• FBC
• Microcytic (MCV < 80)
• Normocytic (MCV 80 -100)
• Macrocytic (MCV > 100)
o Cause.
• Stool
• Urine
• MP slide
• Bone marrow
• Serum ferritin
8

9. Management
 Depends on:
o Severity
o Cause
o Gestational age
o Mild
• Haematinics – orally
• Hb will rise by 0.8 – 1.0g/dl per week.
• Ferrous formulations better than ferric
• Fumerate, sulphate and gluconate formulations
• Multivits have insufficient iron to correct anaemia
9

10. • Amount of elemental iron is what’s important
• 200mg Sulphate( 65mg), 300mg gluconate (35mg), 210mg
fumerate (65mg)
• Previously Recommended dose of elemental iron for
treatment is 100- 200mg , now 40mg- 80mg daily
• Should be taken in the morning and on an empty stomach
taken with water or a vitamin c source.
• Vit C enhances absorption and tannins in tea and coffee
inhibit it.
• Avoid taking with other meds such as antiacids, multivits.
• Check Hb at 2-4 weeks after treatment
10

11. • Iron salts may cause gastric irritation – nausea, vomiting,
abdominal pains.
• Change formulation or reduce the dose in case of adverse
effects.
 IV formulations ( Iron sucrose, iron dextran)
• By-passes gastric absorption
• Less side effects
• Faster absorption, quicker HB improvement
• Indicated in patients with malabsorption, intolerance,
poor compliance and need for rapid Hb boost.
• C.I : anaphylaxis, 1st trimester, active bacteremia and
decompensated liver disease.
11

12. o Moderate
• 1st and 2nd trimester. Orally
• 3rd trimester, term, labour Transfuse.
o Severe
. Transfuse irrespective of gestation age but be careful it
may precipitate cardiac failure if the transfusion is rapid
and massive.
12

13.  Therefore:
i. Use packed cells
ii. Give fast acting diuretic eg frusemide before
transfusion starts.
iii. Slow transfusion.
 Deal with the cause.
o Malaria.
o Infestations – H/worm
o Stop bleeding.
13

14. Prophylaxis
o Diet-haem iron from meat is absorbed 2- to 3- times more readily than non
haem iron.
o Meat also contains organic compounds that promote absorption
o Iron and Folic acid supplements
o Antimalarials eg Fansidar.
o Deworming
o Pre-pregnancy correction of anaemia.
14

15. ■ INTRAPARTUM MANAGEMENT
 Actively prevent blood loss- AMTSL
 Maximize pre-delivery HB
 Women with Hb < 10 should be delivered at a center with an
obstetrician
 Should not determine the mode of delivery.
15