Anemia is a common medical disorder in pregnancy that can lead to increased risks of maternal and infant mortality as well as adverse outcomes like premature delivery and low birth weight. Anemia in pregnancy is defined as a hemoglobin level less than 11g/dl and can account for 20-40% of maternal deaths. Iron deficiency is the most common cause of anemia in pregnancy. Treatment involves dietary changes to increase iron intake, iron supplementation, and blood transfusions in severe cases.

2.  Anemia is the commonest medical disorder in
pregnancy. it is associated with increased rate of
maternal and perinatal mortality premature delivery
,low birth weight and other adverse out comes. It is the
most common pregnancy in developing countries .

3.  Anemia in pregnancy is defined as a hemoglobin
concentration is less than 11g/dl in a venous blood
and anemia is the major contributing or causes in
20-40% of maternal death.
Anamma Jacob

5.  Circulating body fluids include blood and
lymph that flow through a closed of vessels
blood is a fluid connective tissue. The main
function of blood is transportation.

6.  Blood is composed of plasma and blood cells.
 Gases present in blood are oxygen, carbon dioxide
and nitrogen.
 BLOOD CELL OR FORMED ELEMENTS ARE =
45% RBC or erythrocyte [5 million /mm3of blood] WBCs
or leukocytes [4,000-11,000/mm3 of blood].Platelets
are[250,000per mm3 of blood].
 Plasma(55%)
 Water (91%)
 Nutrients(2%)

7.  RED BLOOD CELL-it is a
biconcave disc of 7.3 um
diameter
 Majority of its composed of
water and hemoglobin in the
concentration of 62.5% and 35%
respectively .
 RBC count at birth is 6-7
millions /mm3
 In adults it is 4.5-5.5millions
/mm3

8.  WHITE BLOOD CELL
OR LEUCOCYTE-
 It is a cellular component of
blood cells which lacks
hemoglobin
 Total leukocyte count (TLC)
is 20,000/mm3 at birth.
 It is 4,000-11,000/mm3 in
adult.

9. Different types of WBC
present in the blood
are-
 Granulocytes- WBC
with the granules in
their cytoplasm.
 Neutrophils-they are
50-70% of TLC. Their
size varies between
10-14 micrometer in
diameter.

10.  Eosinophil- they are 14% of TLC .granulocytes with pink
staining granular cytoplasm and purple colored.
 Basophils- they are less than 1% of TLC .granulocytes
with slightly bluish staining .the size varies 10-14 micro
meter diameter.

11.  Agranulocytes –WBC with no
granules in their cytoplasm
are known as agranulocytes
LYMPHOCYTES
 They are 20-40% of TLC
lymphocytes are round to
oval cells with centrally
placed round to oval purple
colored nucleus.They are of
two types.
 Larger
 Small

12.  MONOCYTES-They are
2-8% of irregular cell
outline pale staining
cytoplasm with a single
,kidney shaped pale
staining eccentrically
placed ( present at one
side of the cell)
nucleus is a monocyte.

13.  Platelet are the smallest
blood cell ranging in size
from 2-5 um in
diameter .They are
colorless spherical round
to oval granulated bodies
which do not contain any
nucleus.
 Life span of platelets in
the body is 8-12day they
are destroy by spleen.
 The normal platelet
count of blood is 1.5-4
lacs /mm3.

14.  HAEMOSTASIS –They help in stopping
bleeding from injured part of the body
 BLOOD CLOTTING- platelets help in blood
coagulation.
 PHAGOCYTIC FUNCTION- platelets help in
phagocytosis of foreign particles.
 STRORAGE FUNCTION- serotonin and
histamine are stored in platelets.

15.  Plasma proteins are the
main constituents of
plasma their normal
level is 6-8g/100 ml
there major classes of
plasma proteins.
 Albumin 3-5g/100ml
 Globulin 2-5g/100 ml
 Fibrinogen 0.2-
0.3g/100ml

16.  Hemoglobin or the red
pigment is the most important
constituent of RBC.
 It gives color to the blood.
NORMAL LEVELS-
 Average Hb content in blood
is 14-16g/dl however it varies
depending on age and sex of
the individual.
 Males - 14-18g/dl
 Females- 12-16g/dl
 Infants- 18-23g/dl

18. Transport of
respiratory gases -

19.  Excretion of metabolic
wastes-

20.  Transportation of food-

21.  Chemical coordination
function-

22.  Defense against
injury-

23.  Physiology of anemia
 iron deficiency
 folic acid deficiency
 vitamin b12 deficiency
 protein deficiency
 Hemmhagic anemia
 acute
 chronic

24.  Hemolytic anemia
 jaundice
 sickle cell anemia
 Acquired
 malaria severe infection

25.  Anemia is of two types-
 The deficiency anemia
 Iron deficiency Anemia
 Folic acid deficiency anemia and Vitamin B12
deficiency.
 Protein deficiency anemia.
 Hemorrhagic anemia
 Acute and chronic

26.  Iron deficiency anemia is
anemia caused by a lack of
iron
 About 95% of pregnant
woman with anemia have
the iron deficiency type .A
pregnant woman is said to
be anemia if her
hemoglobin is less than
11g/dl.

28.  INADEQUATE IRON RESERVE – If the mother
a balanced diet and who got an insufficient
iron reserve is likely to develop anemia.
 INCREASED DEMANDS OF IRON –During
pregnancy the demands of iron increased
this amount can not hardly fulfilled by a
normal balanced diet .it is fulfilled by
supplementary. If mother will not take proper
supplement it may lead to anemia

29.  Increased risk of intra uterine hypoxia and
growth retardation
 Prematurity
 Low birth weight
 Increased risk of perinatal morbidity and
mortality

30.  Treatment of severe anemia must be
preceded by an accurate diagnosis of the
causes and type.
 DIET –a balanced diet which is protein iron
and vitamins.
 Iron therapy to raise the hemoglobin and to
restore the iron at last if possible before
women go in labor.
 Appropriate antibiotic to remove even a
minimal septic infection.

31.  It helps in RBC production. Folic acid is needed
for the increased cell growth of mother and
fetus but there is a physiological decrease in
serum folate levels in pregnancy it leads to
anemia.
CAUSES -
 Interference with utilization drugs such as
anticonvulsants sulfonamides and folate
antagonists.
 Infection they reduce life span of RBC and
increased cell production requiring more folic
acid.

32.  A decrease in red blood cell when the body
can’t absorb enough vitamin B12. Deficiency of
vitamin B12 also produces a megaloblastic
anemia .
 PROTEIN-DEFICIENCY ANEMIA
This type of anemia occurs when body doesn’t
have enough iron to produce adequate amounts
of hemoglobin which leads to protein failure .

33.  Hemorrhagic anemia or acute blood loss
anemia is a condition in which a person loses a
large volume of circulating hemoglobin .
 TYPES OF HAEMORRHAGIC ANEMIA-
 ACUTE –acute post hemorrhagic anemia or is
acute blood loss anemia is a condition in which
a person quickly loses large volume of
hemogblin .
 CHRONIC-hookworm infection bleeding piles .

34.  Anemia in pregnancy is present in very high
percentage of pregnant women in India.
 Exact data is not available about prevalence
of nutritional anemia .however according to
WHO ,the prevalence of anemia in pregnancy
in south east Asia is around 56%.
 In India incidence of anemia in pregnancy has
been noted high as 40-80%.

35.  Age group
 Lower socio-economic
status
 Literacy
 Parity
 Malnutrition
 Caloric intake

36.  Iron deficiency
 Increased demand of
iron
 Disturbed metabolism
 Condition requiring
excess demand
 Faulty dietetic habit
 Iron loss
 Pre-pregnant health
status

37.  Lassitude and a feeling
of exhaustion or
weakness may be
earlier manifestation
 Anorexia
 Indigestion
 Dyspnoea
 Giddiness
 Swelling of leg.
 Pallor of mucous
membrane

38.  Hematological
examination
 hemoglobin
 Total red cell count
 Serum iron
 Total iron binding
 Examination of stool
 Urine examination
 Physical examination-

39.  MEDICAL MANAGEMENT-
 Avoidance of frequent child birth
 Supplementary iron therapy
 Dietary advice
CURATIVE MANAGEMENT-
 Diet-a balanced diet which is rich in protein iron and
vitamins.
 Appropriate antibiotic therapy to eradicate even a
minimal septic focus .
 Effective therapy to care the disease contributing to the
cause of anemia.

40.  The daily dose of
iron for treating
anemia is between
120 and 180g in
divided does .
 Iron is best
absorbed in the
ferrous form and
ferrous gluconate
300mg tables are
generally used .

41.  Parenteral iron is
indicated for women
have in tolerance to oral
iron and those with
severe anemia in
advanced pregnancy
[last 8-10 week of
pregnancy]
 Parenteral iron is
contraindicated for
women who have liver or
renal disorder

42.  Blood transfusion is used
rarely to treat severe iron
deficiency anemia. it may used
to raise the Hb level quickly.
 The blood to be transfusion
must be fresh collected within
24 hour and properly grouped.
 Only packed cell are
transfusion and the quantity
should between 80 and 100ml
at time.

43.  The drip should be about 10 drops per
minute and transfusion should not repeated
within 24 hours.
 Prior to the transfusion Patient is to be
sedated with 60 mg phenobarbitone.

45. FIRST STAGE-
The following are the special precaution to be taken
when an anemia patient goes into labor -
 The patient should be in bed and should lie in a
position comfortable to her.
 Light analgesics are preferred for pain relief.
 Oxygen administration to increase the oxygenation
of maternal blood and thus diminish the risk of
fetal hypoxia.
 Strict asepsis to minimize the risk of puerperal
infection.

46.  Usually there is no probler I/V methergine 0.2
mg should be given following the delivery of
anterior shoulder.
THIRD STAGE
 Very vigilant observation is required during the
third stage .significant amount of blood loss
should be replenished by fresh packed cell.
 The volume of blood should not be more than
the amount of blood lost to avoid overloading
the heart.

47.  The patient should be on bed rest
 Any sign of infection should be promptly
detected and treated.
 Predelivery anti-anemic therapy should be
continued until the patient restores her
normal clinical and hematological status.
 Dietary advice outlined earlier mast be
reinforced.
 Pt and family member must be help at home
for body care and household care.

48.  Advise the mother to use
iron utensil for cooking
and the water used in rice
and in cooking vegetable
not be discarded.
 The pregnant women
should get her
hemoglobin level checked
at the first antenatal visit
than 28th week and finally
at 36th week.

49.  Advise the mother to avoid frequent child
birth there should be a minimum interval of 3
year between the pregnancies to replenish
the lost iron during childbirth process and
lactation .
 The initial dose should be 1 tablet thrice daily
with or after meals.
 If larger dose in necessary then maximum 6
tables daily should be given and should be
stopped gradually in 3-4 days .

50. During pregnancy
 Pre –Eclampsia
 Heart-failure
 Preterm labor
During labor
 Uterine Post partum hemorrhage
 Cardiac failure
 Shock
During peuperium
 Sub involution
 Failing lactation

51.  Eat plenty of iron rich
food such as green and
leafy vegetable ,red
meat , and fruit ,bread
 Eat and drink vitamin
rich food .
 Avoid drink tea or
coffice with your diet.

52.  Take iron on an empty stomach (1 hr before or 2
hours after a meal)
 Start with only one tablet per day for few days
,then increased to two tablets per day ,then three
tablets per day.
 Increased intake of vitamin C( citrus fruits and
juices) to enhance iron absorption
 Eat food high in fiber to minimize problems with
constipation.

53.  Anemia during pregnancy is especially a
concern because is associated with low birth
weight prematural birth and maternal
mortality anemia during pregnancy .can be a
mild condition and easily .it can become
dangerous to both the mother and body .if it
goes untreated.