GOVERNMENT COLLEGE OF NURSING

JODHPUR

PRESENTATION
ON
ANEMIA AND NUTRITIONAL DEFICIENCY

SUBMITTED TO: SUBMITTED BY:

JYOTI BALA JANGID PRIYANKA GEHLOT
LECTURER M.Sc.NURSING FINAL
GCON, JODHPUR
 ANEMIA AND NUTRITIONAL DIFICENCY
Introduction:
Anemia in pregnancy is a major health problem in developing countries. More than two
thirds of the pregnant women in India are anemic and most of times it is due to deficiency of
iron and folic acid.

Anemia is a major killer in India. One in every five maternal deaths is directly due to
anemia. Anemic patients have poor tolerance for potential blood loss during deliver and are
poor subjects for surgery. For this purpose, screening for anemia is routine in all antenatal
clinics. Anemia is the commonest hematrological disorder that may occur in pregnancy.

Definition:
Anemia is a condition in which the number of red blood cells or their oxygen carrying capacity is
insufficient to meet the physiological needs of the individual, which consequently will vary by age,
sex, attitude, smoking, and pregnancy status (WHO 2013).

Anemia is a decrease in the RBC count, hemoglobin and/or Hematocrit values resulting in a
lower ability for the blood to carry oxygen to body tissues.

 Mild : 9- 10.9 gm/dl

 Moderate : 7.8- 9 gm/dl
 Severe : < 7 gm/dl
 Very severe : <4 gm/dl

Incidence
Anaemia in pregnancy is present in very high percentage of pregnant women in India. Exact
data is not available about the prevalence of nutritional anaemia. However according to
WHO, the prevalence of Anaemia in pregnancy in south East Asia is around 56 %. In India
incidence of anaemia pregnancy has been noted as high as 40-80%

Risk factors of anemia in pregnancy

 Maternal risk factors-
1. Antenatal Period:
 Poor weight gain
 Preterm labour
 PIH
 Placenta Previa
 PROM
 2. Intranatal Period:
 Dysfunctional Labour
 Intranatal
 Haemorrhage
 Shock
 Cardiac Failure
 Anaesthesia risk
3. Postnatal Period :
 Postnatal sepsis
 Sub involution
 Embolism
Fetal risk factors-
 Prematurity
 Low birth weight
 Poor apgar score
 Foetal distress
 Neonatal Anaemia

CLASSIFICATION OF ANEMIA
1. Physiological Anemia
2. Nutritional deficiency anemia

 Iron deficiency
 Folic acid deficiency
 Vitamin B12 deficiency

3. Hemorrhagic Anemia

 Acute- following bleeding in early months of pregnancy or APH

 Chronic—hookworm infestation, bleeding piles, etc.

4. Hemolytic anemia- Familial congenital jaundice, sickel cell anemia, etc. Acquired—
malaria, severe infection, etc
5. Bone marrow insufficiency hypoplasia or aplasia due to radiation, drugs or severe
infection.
6. Hemoglobinopathie- Abnormal structure of one of the globin chains of the hemoglobin
molecule of globin chains of the hemoglobin molecule ex- sickle cell disease.
1. Physiological anemia of pregnancy:

There is marked demand of extra iron during pregnancy specially in the second half. Even an
adequate diet cannot provide the extra demand of iron. Thus, there always remains a
physiological iron deficiency state during pregnancy. As a result there is not only a fall in
haemoglobin concentration and hematocrit value in the second half of pregnancy but there is
also associated low serum iron,, increased iron binding capacity and increased rate of iron
absorption as found in iron deficiency anemia.

Thus the fall in the haemoglobin concentration during pregnancy is due to combined effect of
hemodilution and negative iron balance.

2. Nutritional deficiency anemia:

a) Iron-deficiency anemia
b) Folate-deficiency anemia
c) Vitamin B12 deficiency

a) Iron Deficiency Anemia -

 This type of anemia occurs when the body doesn't have enough iron to produce adequate
amounts of hemoglobin. That's a protein in red blood cells. It carries oxygen from
the lungs to the rest of the body.

 In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues throughout
the body.

 About 95% of pregnant women with anemia have iron deficiency type.
 A pregnant woman is said to be anemic if her haemoglobin is less than 10 gm/dl.

Causes:
 Blood loss
 poor diet
 reduced intake or absorption of iron
 Multiple pregnancy

Clinical features:

 Pale skin, lips, and nails

 Feeling tired or weak
  Dizziness
 Dyspnea
 Tachycardia and palpitation

Investigation:

 History taking
  Physical examination
 Blood investigations
 Hb%
 CBC (Complete Blood Count)
 PCV (packed cell volume)
 RBC (Red Blood Cell)

Prevention:

 Accurate history of medical, obstetric and social life.

 Pre –pregnancy counselling and dietary advice.
 Iron supplementation weekly iron (60 mg) and folic acid (2.8) shoulb be given.
 Avoidance of frequent childbirths
 Adequate treatments to eradicate illnesses likely to cause anemia
 Early detection of falling hemoglobin level.
 Avoid excessive blood loss during the second stage of labour.
 Delayed clamping of the umbilical cord at delivery (1-2 min.) is important step in
prevention of neonatal anemia.

Nursing management:

 Women having haemoglobin level of 7.5 mg% and those associated with obstetrical
medical complications must be hospitalized.
 Diet – a balanced diet, which is rich in protein, iron and vitamins should be prescribed
and advised.
 Appropriate antibiotic therapy to eradicate even a minimal septic focus.
 Effective theraphy to cure the disease contributing to the cause of anemia.
 Iron therapy to raise the haemoglobin level and to restore the iron reserve at least in
part, if possible, before the women goes into the labour.
 To improve the appetite and facilitate digestion. B-complex medication needs to give.
 Oral iron therapy-
 The initial dose one tablet to be given thrice daily with one or after meals.
 If the large dose is necessary, it should be stepped up gradually in three to four days.
 Daily oral iron (60mg) and folic acid (4mg) should be started and continued upto 6
month postpartum.
 The treatment should be continued till the blood picture becomes normal; thereafter a
maintainance dose of one tablet daily is to be continued for at least 100 days
following delivery to replenish the iron stores.
 Parentral iron therapy- Intravenous and intramuscular route.
 Blood transfusion-
 The indication of blood transfusion in anemia during pregnancy is very rare. The
indication are:
 To correct anemia due to blood loss and to combat postpartum hemorrhage.
  Patient with severe anemia seen in later months of pregnancy to improve the anemic
state and oxygen carrying capacity of blood before the patient goes into labour. The
primary concern is not only to correct anemia but also to make the patient fit to
withstand the strain of labour and blood loss following delivery.

Management during labor-

1 st stage of labour-

 Special precautions
 Comfortable position on bed
 Light analgesia
 Oxygenation to increase oxygenation of maternal blood and prevent fetal hypoxia
 Strict asepsis

2 nd stage of labour-

Asepsis is maintained.

Prophylactic low forceps or vaccum delivery may be done to shorten the duration of second
stage.

Intravenous methargin 0.2 mg should be given following the delivery of anterior shoulder.

3 rd stage of labour

Intensive observation.

blood loss must be replaced by fresh pack cell and amount must not exceed loss amount to
avoid overloading

Puerperium-

Bed rest Sign of infection detected and treated Pre delivery iron therapy must be continued
until patient restores. Die Patient and family members must be counseled for help at home
regarding baby care and household chores

b) Folic Acid Deficiency Anemia (Megaloblastic Anemia) -

 Folic acid deficiency anemia happens when body does not have enough folic acid.
 Folic acid is one of the B vitamins, and it helps your body make new cells, including
new red blood cells.
 It is the second most common cause of nutritional anemia - contributing to 3-4% of all
anemias seen in pregnancy.
 More common in multiparae and in multiple gestation.
 Deficiency of folic acid can cause placental abruption, neueral tube defect and
congenital cardiac septal defects

Risk factors:
  Woman taking anticonvulsants.
 Multiple pregnancy.
 Hemolytic anemia
 Megaloblastic anemia
 Pre-conception deficiency cause neural tube defect and cleft palate etc.

Clinical features:

 Pallor
 Lethargy
 Weight loss
 Depression
 Nausea and vomiting
 Glositis
 Gingivitis
 Diarrhea

Diagnosis:

 Increased MCV ( > 100 fl)

 Peripheral smear
 Low Serum folate level.
 Low RBC folate.

Management: Daily administration of folic acid 5mg orally will lead to a rapid recovery, as
evidenced by reticulocytosis within a week.

c) Vitamin B 12 Deficiency – (Pernicious anemia)

 Vitamin B12 deficiency, also known as hypocobalaminemia, refers to low blood

levels of vitamin B 12. Deficiency of vitamin B 12 can also produce megaloblastic
anemia.

 The body needs vitamin B12 to form healthy red blood cells. When a pregnant woman
doesn't get enough vitamin B12 from their diet, their body can't produce enough healthy
red blood cells. Women who don't eat meat, poultry, dairy products, and eggs have a
greater risk of developing vitamin B12 deficiency, which may contribute to birth defects,
such as neural tube abnormalities, and could lead to preterm labor. Blood loss during and
after delivery can also cause anemia.
SUMMARY:
Today we discussed definition of anemia, classification of anemia risk factors, causes sign
and symptoms, investigation, treatment and management of anemia and prevention of
anemia.

CONCLUSION
Anemia in pregnancy is the most commonly occurring disorder during pregnancy, so every
mother who are pregnant must screen for anemia and must take treatment as soon as possible
along with foods rich in iron and also must have family support and care throughout
pregnancy.
BIBLIOGRAPHY
1. DC Dutta. Textbook of Obstetrics. 8th edition. Jaypee brothers Medical Publishers.
Page no. 260-268
2. Annamma Jacob. A comprehensive textbook of Midwifery & Gynecological Nursing.
3rd edition. Jaypee Brothers Medical Publishers. Page no.323-330.
3. Nima Bhasker. Midwifery & Obstertrical Nursing. 2nd edition. Hardiya Publication.
Page no. 380-384.