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High Risk Pregnancy

Anemia in Pregnancy
Diabetes in Pregnancy
Hypertension in pregnancy
Cardiac disease in pregnancy
Liver disease in pregnancy
Malaria in Pregnancy
HIV infection in pregnancy
Recurrent Abortion
Pregnancy and Renal Disease
Hematological Problems in Pregnancy
Hemoglobinopathies in Pregnancy
Thrombophilia in Pregnancy
 

anemia in pregnancy

Anemia in pregnancy is one of the most common medical disorders in India and is responsible for increased maternal morbidity and mortality. In developing countries nutritional anemia is most common but there are also non-nutritional causes of anemia that may be seen in pregnancy, the sickle cell disorders, the thalassemias, hemolytic anemia, etc. which are reviewed in separate chapter. Prenatal care is the preventive obstetrics. The factors responsible for anemia in pregnancy should be identified and eradicated. Iron supplement to prevent anemia in pregnancy is a well known strategy. The National Nutritional Anemia Prophylaxis Program (NNAPP) advised 60 mg of elemental iron and 500 \ig of folic acid daily for 100 days to all pregnant women. Inaccessibility of such program, noncompliance and gastrointestinal malabsorption still remain as major causes of anemia in our country. Malaria and hookworm prophylaxis must be considered in endemic area. Prevention and management of nutritional anemia is easy and cheap. Along with the support of the Government, the support of the family, social workers, schoolteachers, media, etc. is necessary.
 
EFFECTS OF ANEMIA ON PREGNANCY
  • Mild anemia may not have any adverse effect on pregnancy and labor.
  • Moderate anemia causes weakness, fatigue and poor work performance.
  • Severe Anemia causes
 
EFFECTS OF PREGNANCY ON ANEMIA
  • Pregnancy aggravates any pre-existing anemia
  • Severely anemic patients become symptomatic by the end of second trimester
 
RISK PERIODS FOR MATERNAL MORTALITY
  1. 30-32 weeks of pregnancy
  2. During labor
  3. Immediately following delivery
  4. Puerperium (pulmonary embolism, cardiac failure)
 
IRON DEFICIENCY ANEMIA
Iron deficiency anemia has been defined as microcytic hypochromic anemia, when body iron store becomes inadequate for the need of normal erythropoiesis. Body iron store must be exhausted before red cell production is reduced; therefore, anemia occurs at a late stage of iron deficiency. Iron store depletion occurs as a result of an imbalance between normal physiological demands such as body growth, menstrual blood loss and pregnancy,and the level of dietary iron intake, the efficiency of iron absorption and utilization
 
Rich Sources

Liver, meat, poultry, fish, eggs, yolk, dry fruits, beans, green leafy vegetables, legumes, nuts, jaggery, apple, banana.

 
Poor Sources

Milk and milk products

  • Although iron absorption is increased during pregnancy, the absorbed iron and the iron mobilized from stores are usually inadequate to meet the demands. Iron supplementation, therefore, becomes necessary during pregnancy especially in the non-industrialized countries.9
  • The fetus obtains iron from maternal transferin regardless of maternal iron stores. The placenta traps maternal transferrin, removes the iron, and actively
  • transports it to the fetus, mainly in the last 4 weeks of pregnancy.
 

Factors affecting the iron status of a pregnant woman

Iron absorption

Iron loss

Dietary iron (heme and nonheme)

Physiological factors
Basal losses from desquamation from Intestines and
Enhancers of absorption skin

Heme iron

Menstruation

Proteins

Delivery

Meat

Lactation

Ascorbic acid

Pathological factors

Fermentation

Hookworm and other helminths

Ferrous iron

Hemorrhage from GIT

Gastric acidity

Allergies

Alcohol

Occult blood losses

Low iron stores

 

Increased erythropoietic activity(high altitude,

 

hemolysis, bleeding)

 

Inhibitors of iron absorption

 

Phytates

 

Calcium

 

Tannins

 

Tea and coffee

 

Herbal drinks

 

Fortified iron supplements

 

 
TREATMENT
Prevention
  • Prophylaxis in non pregnant women
  • Iron supplementation during pregnancy
  • Treatment of worm infestation
  • Improvement of dietary habits
  • Improvement of sanitation and personal hygiene
  • Improvement of female literacy status
  • Food fortification with iron.
  • Reproductive interventions.
 
Curative Treatment

General Measures

  • Diet rich in iron, protein and vitamins is prescribed
  • Treatment of the cause of anemia.

Specific Therapy
Principles

  • To raise the Hb as near as normal
  • To replenish iron stores.

Choice of Therapy (depends upon)

  • Severity of anemia
  • Duration of pregnancy
  • Associated complications
 
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