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Anaemia in pregnancy

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Bharati vidyapeeth university

This document discusses anemia in pregnancy. It defines anemia as having insufficient red blood cells or hemoglobin. Anemia is common in pregnancy, affecting 18-75% of pregnant women globally. Anemia is classified as mild, moderate or severe based on hemoglobin levels. Common causes of anemia in pregnancy include iron deficiency, folic acid deficiency, vitamin B12 deficiency, and genetic disorders like sickle cell anemia. Left untreated, anemia can negatively impact both mother and baby by increasing risks of infection, hemorrhage, low birth weight, and other complications. Routine screening and treatment with iron, folic acid and other supplements can help prevent and manage anemia during pregnancy.

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ANEMIA IN PREGNANCY PRESENTED BY: Ms. Lisa Chadha S. Y. Msc. Nursing Pune
INTRODUCTION • Commonest medical disorder in pregnancy. • 18-20 pregnant women are anaemic in developed countries as compared to 40-75 % in developing countries . • It is responsible for significant high maternal and fetal mortality rate worldwide.
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 in pregnancy • Anemia in pregnancy is defined as haemoglobin (Hb) concentration is less than 11 g/dl.
CLASSIFICATION • Mild : 9- 10.9 gm/dl • Moderate : 7.8- 9 gm/dl • Severe : < 7 gm/dl • Very severe : <4 gm/dl
CLASSIFICATION OF ANEMIA 1. Physiological Anemia 2. Pathological 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. Hemoglobinopathies Abnormal structure of one of the globin chains of the hemoglobin molecule of globin chains of the hemoglobin molecule ex- sickle cell disease
PHYSIOLOGICAL ANEMIA OF PREGNANCY • During pregnancy, maternal plasma volume gradually expands by 50%, an increase of approximately 1,200 ml by term. • Most of the rise takes place before 32nd to 34th week’s gestation and thereafter there is relatively little change (Letsky, 1987). • The total increase in red blood cells is 25%, approximately 300 ml that occurs later in pregnancy. This relative hemo-dilution produces a fall in haemoglobin concentration, thus presenting a picture of iron deficiency anemia. • However, it has been found that these changes are a physiological alteration of pregnancy necessary for the development of fetus.
ERYTHROPOISIS • In adults, erythropoiesis is confined to the bone marrow. • Red cells are formed through stages of pronormoblasts- normoblasts- reticulocytes-nature nonnucleated erythrocytes • • The average life- span of red cells is about 120 days after which the RBC’s degenerate and the haemoglobin are broken into hemosiderin and bile pigment.
IRON REQUIREMENTS IN PREGNANCY During pregnancy approximately 1,500 mg iron is needed for:- Increase in maternal haemoglobin (400-500mg) The fetus and placenta (300-400 mg) Replacemet of daily loss through urine, stool and skin (250mg) Replacement of blood lost at delivery (200mg) Lactation (1mg/day)
IRON AND FOLIC ACID REQUIREMENT IN PREGNANCY Elemental iron- 30 mg to 60 mg Folic acid- 400 µg (0.4 mg) It is recommended for pregnant women to prevent maternal anemia, puerperal sepsis, low birth weight, and preterm birth of babies.
IRON DEFICIENCY ANEMIA • 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 • Reduced intake or absorption of iron • Excess demand such as multiple pregnancy • Blood loss
EFFECTS OF ANEMIA ON THE MOTHER • Reduced resistance to infection caused by impaired cell-mediated immunity • Reduced ability to withstand postpartum hemorrhage • Strain of even an uncomplicated labor may cause cardiac failure • Predisposition to PIH and preterm labor due to associated malnutrition • Reduced enjoyment of pregnancy and motherhood owing to fatigue • Potential threat to life.
EFFECTS TO FETUS/ BABY • Intrauterine hypoxia and growth retardation • Prematurity • LBW • Anemia a few months after birth due to poor stores • Increased risk of perinatal morbidity and mortality
PREVENTION OF IRON DEFICIENCY ANEMIA • The midwife can help to identify women at risk of anemia by • Accurate history of medical, obstetric and social life
MANAGEMENT • Avoidance of frequent childbirths • Supplementary iron therapy • Dietary advice • Adequate treatments to eradicate illnesses likely to cause anemia • Early detection of falling hemoglobin level
CURATIVE MANAGEMENT • Women having haemoglobin level of 7.5 mg% and those associated with obstetrical medical complications must be hospitalized. • Following therapeutic measures are to be instituted: • Diet • Antibiotic therapy • Blood transfusion • Iron therapy which may be oral/ parental • Oral iron: daily dose 120- 180 gm is given.
MANAGEMENT DURING LABOR
1st stage Special precautions Comfortable position on bed Light analgesia Oxygenation to increase oxygenation of maternal blood and prevent fetal hypoxia Strict asepsis
2nd stage Usually no problem.  IV Methergin 0.2mg or 20 units oxytocin in 500ml RL IV and 10units of IM given.
3rd stage 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.  Diet  Patient and family members must be counseled for help at home regarding baby care and household chores
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 • Deficiency of folic acid can cause placental abruption, nueral tube defect and congenital cardiac septal defects
VITAMIN B 12 DEFICIENCY  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.  Deficiency is most likely in vegetarians who eat no animal product.
SICKLE CELL ANEMIA  Sickle cell anemia is a disease in which body produces abnormally shaped red blood cells.  The cells are shaped like a crescent or sickle.  They don't last as long as normal, round red blood cells. This leads to anemia.  The sickle cells also get stuck in blood vessels, blocking blood flow. This can cause pain and organ damage
THALESEMIA SYNDROMES: • The Thalesemia syndrome are commonly found genetic disorders of the blood. • The basic defect is reduced rate of haemoglobin chain synthesis. This leads to ineffective erythropoisis and increased hemolysis with resultant inadequate haemoglobin content.the syndrome are of two types: • The alpha and beta thalesemia depending on the globin chain synthesis affected
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 • D.C Dutta’s, “ Textbook of Obstetrics”, 7th ed. 2013, New Central Book Agency ( P) Ltd, London, page no:- 260- 268 • Annamma Jacob, “ A Comprehensive textbook of midwifery & gynaecological nursing”, 3rd ed. 2012, Jaypee Brothers Medical Publishers (P) Ltd., page no:323-330 • Myles, “textbook of midwies”, 6th ed.2014, Elvester (Ltd), page no: 273-275 • Lowdermilk, Perry& Bobak, “Maternity & Women’s Health Care”, 6th ed. 1996, page no:846 • www.anemiainpregnancy.com
Anaemia in pregnancy

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Anaemia in pregnancy

  • 1. ANEMIA IN PREGNANCY PRESENTED BY: Ms. Lisa Chadha S. Y. Msc. Nursing Pune
  • 2. INTRODUCTION • Commonest medical disorder in pregnancy. • 18-20 pregnant women are anaemic in developed countries as compared to 40-75 % in developing countries . • It is responsible for significant high maternal and fetal mortality rate worldwide.
  • 3. 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).
  • 4. Anemia in pregnancy • Anemia in pregnancy is defined as haemoglobin (Hb) concentration is less than 11 g/dl.
  • 5. CLASSIFICATION • Mild : 9- 10.9 gm/dl • Moderate : 7.8- 9 gm/dl • Severe : < 7 gm/dl • Very severe : <4 gm/dl
  • 6. CLASSIFICATION OF ANEMIA 1. Physiological Anemia 2. Pathological 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.
  • 7. 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. Hemoglobinopathies Abnormal structure of one of the globin chains of the hemoglobin molecule of globin chains of the hemoglobin molecule ex- sickle cell disease
  • 8. PHYSIOLOGICAL ANEMIA OF PREGNANCY • During pregnancy, maternal plasma volume gradually expands by 50%, an increase of approximately 1,200 ml by term. • Most of the rise takes place before 32nd to 34th week’s gestation and thereafter there is relatively little change (Letsky, 1987). • The total increase in red blood cells is 25%, approximately 300 ml that occurs later in pregnancy. This relative hemo-dilution produces a fall in haemoglobin concentration, thus presenting a picture of iron deficiency anemia. • However, it has been found that these changes are a physiological alteration of pregnancy necessary for the development of fetus.
  • 9. ERYTHROPOISIS • In adults, erythropoiesis is confined to the bone marrow. • Red cells are formed through stages of pronormoblasts- normoblasts- reticulocytes-nature nonnucleated erythrocytes • • The average life- span of red cells is about 120 days after which the RBC’s degenerate and the haemoglobin are broken into hemosiderin and bile pigment.
  • 10. IRON REQUIREMENTS IN PREGNANCY During pregnancy approximately 1,500 mg iron is needed for:- Increase in maternal haemoglobin (400-500mg) The fetus and placenta (300-400 mg) Replacemet of daily loss through urine, stool and skin (250mg) Replacement of blood lost at delivery (200mg) Lactation (1mg/day)
  • 11. IRON AND FOLIC ACID REQUIREMENT IN PREGNANCY Elemental iron- 30 mg to 60 mg Folic acid- 400 µg (0.4 mg) It is recommended for pregnant women to prevent maternal anemia, puerperal sepsis, low birth weight, and preterm birth of babies.
  • 12. IRON DEFICIENCY ANEMIA • 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.
  • 13. CAUSES • Reduced intake or absorption of iron • Excess demand such as multiple pregnancy • Blood loss
  • 14. EFFECTS OF ANEMIA ON THE MOTHER • Reduced resistance to infection caused by impaired cell-mediated immunity • Reduced ability to withstand postpartum hemorrhage • Strain of even an uncomplicated labor may cause cardiac failure • Predisposition to PIH and preterm labor due to associated malnutrition • Reduced enjoyment of pregnancy and motherhood owing to fatigue • Potential threat to life.
  • 15. EFFECTS TO FETUS/ BABY • Intrauterine hypoxia and growth retardation • Prematurity • LBW • Anemia a few months after birth due to poor stores • Increased risk of perinatal morbidity and mortality
  • 16. PREVENTION OF IRON DEFICIENCY ANEMIA • The midwife can help to identify women at risk of anemia by • Accurate history of medical, obstetric and social life
  • 17. MANAGEMENT • Avoidance of frequent childbirths • Supplementary iron therapy • Dietary advice • Adequate treatments to eradicate illnesses likely to cause anemia • Early detection of falling hemoglobin level
  • 18. CURATIVE MANAGEMENT • Women having haemoglobin level of 7.5 mg% and those associated with obstetrical medical complications must be hospitalized. • Following therapeutic measures are to be instituted: • Diet • Antibiotic therapy • Blood transfusion • Iron therapy which may be oral/ parental • Oral iron: daily dose 120- 180 gm is given.
  • 20. 1st stage Special precautions Comfortable position on bed Light analgesia Oxygenation to increase oxygenation of maternal blood and prevent fetal hypoxia Strict asepsis
  • 21. 2nd stage Usually no problem.  IV Methergin 0.2mg or 20 units oxytocin in 500ml RL IV and 10units of IM given.
  • 22. 3rd stage Intensive observation. blood loss must be replaced by fresh pack cell and amount must not exceed loss amount to avoid overloading
  • 23. Puerperium  Bed rest  Sign of infection detected and treated  Pre delivery iron therapy must be continued until patient restores.  Diet  Patient and family members must be counseled for help at home regarding baby care and household chores
  • 24. 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 • Deficiency of folic acid can cause placental abruption, nueral tube defect and congenital cardiac septal defects
  • 25. VITAMIN B 12 DEFICIENCY  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.  Deficiency is most likely in vegetarians who eat no animal product.
  • 26. SICKLE CELL ANEMIA  Sickle cell anemia is a disease in which body produces abnormally shaped red blood cells.  The cells are shaped like a crescent or sickle.  They don't last as long as normal, round red blood cells. This leads to anemia.  The sickle cells also get stuck in blood vessels, blocking blood flow. This can cause pain and organ damage
  • 27. THALESEMIA SYNDROMES: • The Thalesemia syndrome are commonly found genetic disorders of the blood. • The basic defect is reduced rate of haemoglobin chain synthesis. This leads to ineffective erythropoisis and increased hemolysis with resultant inadequate haemoglobin content.the syndrome are of two types: • The alpha and beta thalesemia depending on the globin chain synthesis affected
  • 28. 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. •
  • 29. BIBLIOGRAPHY • D.C Dutta’s, “ Textbook of Obstetrics”, 7th ed. 2013, New Central Book Agency ( P) Ltd, London, page no:- 260- 268 • Annamma Jacob, “ A Comprehensive textbook of midwifery & gynaecological nursing”, 3rd ed. 2012, Jaypee Brothers Medical Publishers (P) Ltd., page no:323-330 • Myles, “textbook of midwies”, 6th ed.2014, Elvester (Ltd), page no: 273-275 • Lowdermilk, Perry& Bobak, “Maternity & Women’s Health Care”, 6th ed. 1996, page no:846 • www.anemiainpregnancy.com