3. ANAEMIA
Anemia is a condition in which lack of enough healthy
red blood cells to carry adequate oxygen to body tissues
or
Hb concentration of less than11g/dL and a hematocrit of
less than 33% is defined as anemia in pregnancy
4. Severity of anemia in pregnancy
● Mild anemia-9-10.9gm
● Moderate anemia-7-9.9g/dL
● Severe anemia-<7.0g/dL
● Very severe anemia-<4.0g/dL
5. Classification
• Physiological anemia of pregnancy
• Pathological
• Deficiency anemia (isolated or combined)
Iron deficiency Folic acid deficiency Vitamin B12 deficiency
6. Physiological anemia of pregnancy
• Physiological adaptation in pregnancy leads to
physiological anemia of pregnancy.
• This is because the plasma volume expansion is
greater than red blood cell (RBC) mass increase
which causes hemodilution.
• Normal pregnancy increases iron requirement by 2–
3 fold and folate requirement by 10–20 fold.
7. Etiology
• Increased demands of iron
• Diminished intake of iron
• Pre – pregnant health status
• Excess demand: multiple pregnancy, rapidly recurring
pregnancy.
8. Iron deficiency anemia Vitamin B12 Folic acid deficiency
Etiology
• Increased demand
of iron
• Diminished intake of
iron
• Diminished
absorption
• Pre pregnant health
status
• Strict vegetarian
diet
• Gastritis
• Gastrectomy
• Crohn’s disease
• Drugs -
metformin,
proton pump
inhibitors
• Megaloblastic
anemia of
malabsorption
syndrome.
Inadequate intake due to:
● Nausea, vomiting
● Loss of appetite.
● Dietary insufficiency
Increased demand due to:
● Increased maternal
tissue including red
cell volume
● Growing fetus
● Multiple pregnancy
● Diminished
absorption
● Iron deficiency
anemia
9. Iron deficiency anemia Vitamin B12 Folic acid deficiency
Clinical
features
Symptoms
• Feeling of exhaustion
or weakness
• Anorexia
• Indigestion
• Palpitation
• Dyspnoea
• Giddiness
• Swelling of legs
•Weakness
•Heart palpitations
and shortness of
breath
•A smooth tongue
•Constipation,
diarrhea, loss of
appetite
•Muscle weakness,
•Anorexia or protracted
vomiting
•Occasional diarrhea
•Constitutional symptom
like unexplained fever is
often associated.
Signs
• Pallor
• Edema of legs
• Brittle nail
• Crepitations (a
crackling or rattling
sound) at the base of
the lungs due to
congestion
•Pale skin ● Pallor of varying
degree
● Ulceration in the
mouth (glossitis) and
tongue
● Hemorrhagic
patches under the
skin and conjunctiva
● Enlarged liver and
spleen
10. Iron deficiency anemia Vitamin B12 Folic acid deficiency
Investigations
• Haemoglobin:
• Total red cell count(less
than 4 million/mm3)
• Packed cell volume(less
than 30%)
• Peripheral blood smear
• Haematological indices
-PCV - checking
packed cell volume.
-MCHC-
• Examination of stool
• Examination of urine
• Bone marrow study
•Serum vitamin B12.
•Serum folate.
•Full blood count (to
check haemoglobin,
mean corpuscular
volume, and
haematocrit)
● Hemoglobin level
is usually below
10 gm%
● Red cell folate-<3
ng/ml (normal
non-pregnant
level being 2.8–8
ng/ml)
● Serum vitamin
B12 level -< 90
pg/ml (normal
levels 300 pg/ml)
12. Iron deficiency anemia
Prevention
• Avoidance of frequent child birth
• Supplementary iron therapy(200mg of ferrous
sulphate) along with 1mg folic acid
• Dietary modification:
-Consumption of iron rich foods such as jaggery,
green leafy vegetables, cereals, sprouted pulses.
13. ● Adequate treatment of malaria,worm
infestation,dysentery ,piles etc.
● Avoidance of excessive tea and coffee intake.
● avoiding overcooking of food to prevent loss of
folate and other vitamins
● Antenatal care for early recognition and prompt
treatment of deficiency
16. Oral route
• Available preparations:ferrous gluconate,ferrous
fumarate,ferrous succinate,ferrous sulphate
• Dosage:200 mg tablet contains
60 mg elemental iron
:-Iron supplemetation after about week
12 of gestation (the beginning of the
second trimester)
17. Parenteral therapy
Intravenous route
The compound used:Iron dextran or iron sucrose
Intramuscular route
• Compound used:iron dextran(imferon) or iron
sorbitol citric acid complex in dextran.
• Using Z track technique
• After test dose the injections are given daily or on
alternate days in doses of 2 ml IM
18. Blood transfusion
• Only packed cell are transfused:
Packed cell are red blood cells that have been separated for
blood transfusion. RBCs are used to restore oxygen-carrying
capacity in patients with anemia
• The quantity should be between 80-100 ml at a time
Increased amount of blood volume
can cause complications like
anaphylaxis, fluid overload ,lung injury
19. Management during labor
• Strict asepsis
• Arrangement for oxygenation
• Methergine IM -0.2mg should give following the
delivery of anterior shoulder
• Blood transfusion at third stage
• Prophylactic antibiotics in puerperium
• Continue iron therapy for at least 3 months following
delivery
20. Megaloblastic anemia
Treatment
• Injections hydroxocobalamin or cyanocobalamin
- Initially:30 mcg IM once daily for 5-10 days
- Maintenance: 100-200 mcg IM monthly
• Very effective at raising blood levels of B12
• Adding more foods with vitamin B-12 diet can improve the
condition.
• Foods that have vitamin B-12 in them include:
Eggs, chicken, fortified cereals (especially bran), red meats
(especially beef),milk, shellfish
21. Folic acid deficiency anemia
Treatment
Prophylactic Therapy
● All pregnant woman should be given 400 µg of folic
acid daily during first trimester. (0-3months)
● Additional amount (4 mg) should be given in
situations where the demand is high
Curative
● Folic acid -4 mg orally daly,which should be
continued for at least 4 weeks following delivery.
● Supplementation of 1 mg of folic acid daily along
with iron and nutritious diet
22. Nursing diagnosis
● Fatigue related to decreased hemoglobin and
diminished oxygen-carrying capacity of the blood.
● Imbalanced nutrition less than body requirements
related to inadequate food intake to utilize
nutrients
● Risk for Infections related to inadequate secondary
defenses due to decrease in hemoglobin level
● Activity intolerance related to imbalance between
oxygen supply and demands
23. Fatigue related to decreased hemoglobin and
diminished oxygen-carrying capacity of the blood.
● Assess the client’s ability to perform activities of
daily living , and the demands of daily living
● Monitor hemoglobin, hematocrit, RBC counts
● Provide supplemental oxygen therapy, as needed.
● Administer IM or IV iron when oral iron is poorly
absorbed
● Advise patient to take iron supplements an hour
before meals for maximum absorption
24. Imbalanced nutrition less than body requirements
related to inadequate food intake to utilize nutrients
● Encourage patient to eats high iron diet and
protein diet, like jaggery, green vegetables,
beans, fruits etc.
● Discourage caffeinated or carbonated beverages.
● Encourage exercise.(Metabolism and utilization
of nutrients are improved by activity)
● Encourage patient participation in recording a
food intake
25. Risk for Infections related to inadequate secondary
defenses due to decrease in hemoglobin level
● Assess for local or systemic signs of infection,
such as fever, chills, swelling, pain, and body
malaise.
● Encourage patient to eats high iron diet and
protein diet, like green vegetables, beans, fruits
etc.
● Encourage to use iron and folic supplements as
prescribed. (In order to increase Hb level and to
correct sign of anemia and to boost immunity
26. Activity intolerance related to imbalance between
oxygen supply and demands
● Assess client’s ability to perform normal
tasks,weakness.
● Monitor BP,Pulse, respiration during and after
activity
● Recommended quiet atmosphere, bed rest if
indicated
● Provide assistance with ambulation
27. Reference
● Dutta D.C, Textbook of Obstetrics,8th edition,New
Delhi,Jaypee Brothers medical publisher
Limited.201,p:304-315
● Reader.Martin.Koniak-Griffin maternity
Nursing.Family, newborn, and women’s health
care.19th edition,New Delhi,Wolters Kluwer
publisher, 2014, p:640-643.
