Anaemia in pregnancy is defined as a haemoglobin level less than 10 g/dl. It is graded as mild (8-9.9 g/dl), moderate (6-7.9 g/dl), or severe (below 6 g/dl). Clinical signs include fatigue, weakness, dizziness, and pallor of the skin, gums, and nails. Differential diagnoses that can present similarly include nephrotic syndrome, cardiac disease, and hypertension. Investigations include haemoglobin tests at first contact and 36-38 weeks, as well as additional tests depending on diagnosis. Immediate management of severe anaemia includes referral to the hospital with supportive care such as oxygen, while in the hospital transfusion

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).