anemia in pregnancy

1. ANAEMIA IN PREGNANCY
AHMED ABDULWAHAB

2. • objectives
• 1-describe the physiological changes in
pregnancy increasing the risks of anemia
• 2- List the different types of anemia in
pregnancy
• 3- Describe the sign and symptoms in
anemic pregnant lady
• 4- List the different investigations to
identify the causes of anemia

3. • Justify different mode of managements for
anemia according to types severity and
gestational age .

4. • It is the commonest medical disorder of
pregnancy.
• Physiological changes.
• Plasma volume increase by 50%.
• Red cell mass increase by 25%.
• Fall in Hb concentration and haematocrit
due to haemodilution.
• MCV increase secondary to erythropoiesis.

5. • Cont,
• MCHC remain stable.
• Serum iron and ferritin decrease because of
utilization .
• Total iron binding capacity increases TIBC
• Iron requirement increases total of 1000 mg in
whole pregnancy.
• Moderate increase in iron absorption .
• Folate requirement increases

6. • DEFINTION..
• WHO recommended that Hb concentration
should fall below 11gm/dl in pregnancy to
diagnose anemia.
• Incidence 30-50% pregnant women are
having anemia at pregnancy.
• 90% have iron deficiency anemia .
• 5% folate deficiency .

7. • CLINICAL FEATURE.
• Often asymptomatic.
• Diagnosed in routine screening .
• Other ,tiredness, dizziness ,fainting , pallor
may be apparent

8. • SCREENING .
• Routine screened by Hb concentration at
the beginning of pregnancy .
• It is cheep and simple..
• It does not reveal the cause .

9. • IRON DEFICENCY ANAEMIA .
• It is microcytic hypochromic . Reduced
MCV . MCHC.
• Etiology .
• Increase demand in pregnancy due to
expanding red cell mass, fetal requirement
.If iron stores are depleted because of
menstruation , recurrent pregnancy ,poor
intake , anemia develops rapidly

10. • CONSEQUENCES .
• Preterm labor.
• Infection
• Medical intervention during labor .
• Post partum blood loss.
• ? IUGR.

11. • TREATMENT.
• Oral iron is effective when there is time .
• Hb increase 0.8 g/dl per week
• Side effect depends on the amount of the
of the elemental iron .
• Choice depends on cost and patient
tolerance .

12. • Cont.
• Vitamin –C helps absorption .
• Main side effect are gastro intestinal ,
gastric upset and constipation .
• Indication for parenteral thereby .
• Lack of compliance , severe GIT side
effect, mal absorption
• Intera muscular iron sorbitol

13. • Cont.
• Deep im it is painful cause discoloration
of the skin .
• High level may be excreted before
utilization .
• IV IRON .
• Iron saccharate cause more rapid rise in
Hb and has fewer side effect compared to
oral iron , but more invasive and need

14. • Cont
• Blood transfusion
• Most rapid way to increase the Hb .
• Used when there is no time to correct
anemia especially when there is an
obstetrical problem eg, placenta previa
• Risks include allergy and transmission of
infection

15. • Cont.
• Prevention is possible with good balanced diet .
• Spacing pregnancies .
• Identification and treatment of iron deficiency
prior to pregnancy are optimal .
• Routine iron supplementation in pregnancy
improve in hematological indices.