Title ANEMIA & ANTEPARTUM HAEMORRHAGE ✅

ANEMIA IN PREGNANCY Ref : RCOG anemia in pregnancy https://www.rcog.org.uk/media/sdqcorsf/gtg-47.pdf Case 1 Anemia in pregnancy ( claimed multiple preg + thyroid and heart disease) how would u decide to deliver this patient Definition ● (RCOG) First trimester haemoglobin (Hb) less than 11 g/dL, second or third trimester Hb less than 10.5 g/dL, and postpartum Hb less than 10 g/dL ● (WHO) Hb concentration less than 11 g/dL Physiological adaptation in pregnancy ● Plasma volume expansion (50%) greater than red cell mass (25%). ● This leads to physiological dilution with d Hb and haematocrit. ● Anaemia is diagnosed if Hb <10.5 g/dL in pregnancy. ● There should be no change in mean corpuscular volume (MCV) or mean corpuscular haemoglobin concentration (MCHC) in normal pregnancies. ● Normally pregnancy has: ○ 2–3-fold increase in iron requirements ○ 10–20-fold increase in folate requirements in pregnancy Oxford pg 199
Clinical features History ● Fatigue ● Weakness ● Dyspnoea ● Dizziness ● Palpitation ● Indigestion ● Loss of appetite ● Generalized swelling ● Fainting Physical examination ● Pallor ● Facial swelling ● Angular stomatitis ● Glossitis ● Koilonychia ● Peripheral edema ● Raised JVP ● Tachycardia ● Haemic murmur ● Fine crepitations at lung bases ● Heart failure signs ● Hepatosplenomegaly ● Jaundice ● Purpura - bleeding disorder ● In severe cases – IUGR may be present, fundal height
< dates, small fetus ● Evidence of chronic disease – Renal , TB Effects of anaemia on pregnancy Maternal ● Heart failure ○ e.g. ventricular failure, arrhythmias, β-thalassaemia major due to hemosiderosis ● Infection ○ IDA associated with impairment of natural immunity and cell immediate immunity ● Risk of PPH (moderate anemia) ○ 50% increased risk of PPH, more susceptible to uterine atony due to impaired oxygen transport to uterus Fetal ● IUGR ● SGA ● Hypoxia ● Preterm delivery ● Neural tube defect ● Hydrops fetalis Investigation ● Full blood count ● Serum Ferritin – abnormal if < 20 ng/ml (N 40-160 ng/dl), assess iron stores ● Serum Iron – N 65-165 ug/dl, decreases in IDA ● Serum Iron binding capacity – 300-360 ug/dl, increases with severity of anemia Others ● Serum B12 & folate ● Renal profile : chronic kidney disease ● Urine exams : RBC & cast
● Stool exams : occult blood, ovum ● Bone marrow exams : refractory anemia ● HB electrophoresis : HbA2, HbF ● Peripheral blood film : pencil cells ● X-ray of chest : pulmonary tb Management NICE guidelines recommend that women are screened for anaemia at booking and again at 28 weeks gestation. ● Principle : ○ To achieve normal hb before delivery ○ To replenish iron loss and iron store ● Methods ○ Dietary advice ○ Oral iron therapy ○ Parenteral iron therapy ○ Blood transfusion During booking ● <11 g/dL ○ Start on trial of oral iron ■ Diagnostic and therapeutic ■ Rise in HB after 2 weeks support the dx of IDA ○ Necessary dose : 100-200mg of elemental iron daily ○ Repeat HB level 2-3 weeks litre– if no rise despite compliance , check for serum ferritin ● <9 g/dl ○ Start oral iron in divided doses/days ○ Refer to obstetrician if symptomatic ● <7 g/dl ○ Urgent referral to tertiary hospital to investigate further and make mx ○ Do not offer blood transfusion unless symptomatic/ongoing blood loss At 28 weeks : All women should have HB rechecked ● < 10.5g/dl ○ Start on trial of oral iron ○ Recheck HB in 3 weeks ○ If no response, check serum ferritin and refer to obstetrician to consider total dose iron infusion ● < 9 g/dl ○ Start oral iron 200 mg elemental iron in divided doses/day ○ Refer if symptomatic CBD anemia in pregnancy https://docs.google. com/presentation/d /1IG_LIdASEwEXVIfx LLzTzRnX12Qle8sL/e dit#slide=id.p51