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ANAEMIA

ANAEMIA. In pregnancy. Def- anaemia in pregnancy is said to be present when Hb is 11gm / 100 ml or less. Classification – Physiological-due to expansion of plasma volume , and increased. demand for iron and vitamins . Pathological-

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ANAEMIA

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  1. ANAEMIA In pregnancy

  2. Def- anaemia in pregnancy is said to be present when Hb is 11gm / 100 ml or less. • Classification – • Physiological-due to expansion of plasma volume , and increased

  3. demand for iron and vitamins . • Pathological- • 1.Deficiency anaemia – iron deficiency anaemia is commonest , folic acid def., vitamin B12 def.,protein def., • 2.Haemorrhagic- due to APH, haemorrhoids, hookworm infestation

  4. 3.hereditary-thalassemias, haemoglobinopathies, haemolytic • 4.anaemia of infection – malaria , TB. • 5.bone marrow insufficiency- hypoplasia , aplasia . • 6.chronic diseases – renal , neoplasm, etc.

  5. IRON DEFICIENCY ANAEMIA • Symptoms- • 1.tiredness / weakness • Loss of appetite • 3.indigestion • 4.palpitation • 5.breathlessness • 6.giddiness • 7.swelling of legs.

  6. O/E- • 1.pallor 2.glossitis 3.stomatitis 4.oedema of leg 5.soft systolic murmur 6.crepitations. • Investigations-Hb, blood for TC, Peripheral blood picture and PCV, R/E –stool , urine R/E –complete. • A typical iron deficiency anaemia shows-Hb - < 10gm %,RBC - < 4 million/cubic mm , PCV - < 30%.

  7. COMPLICATIONS OF SEVERE ANAEMIA- • 1.pre-eclampsia • 2.infection • 3.heart failure • 4.preterm labour • 5.PPH- is a great threat • 6.shock • 7.pulmonary embolism • 8.failing lactation

  8. HIGH RISK PERIODS- • Patient may die suddenly in severe anaemia ( Hb < 7gm % )- 1.at about 30-32 weeks of pregnancy 2.during labour 3. following delivery 4.any time in puerperium – after a week following delivery due to pulmonary embolism

  9. PROGNOSIS- • Good , if detected early and treated properly . • TREATMENT- • a. prophylactic – • 1.spacing of 2 – 3yrs between pregnancies. • 2.daily – 60mg elemental iron along with 1mg folic acid – minimum 100 days • 3.balanced diet , rich in iron , protein and vitamins

  10. b. therapeutic – • oral therapy- 60mg elemental iron + 1mg folic acid given 2-3 times daily with/after meals .followed by once daily for 100 days after delivery to replenish iron stores.

  11. Response of therapy is evidenced by – • 1.sense of well being • 2.increased appetite • 3.haematological exam –rise in Hb , haematocrit returning to normal. • CONTRAINDICATIONS OF ORAL THERAPY- • 1severe anaemia in adv. Pregnancy • 2.intolerance to oral iron

  12. Parenteral therapy- • Iron - dextran (imferon), • Iron – sorbitol complex (jectofer) • Both of them contain 50mg of elemental iron in one ml . • Given intramuscularly daily / alternate days in doses of 1ml initially followed by 2ml deep intramuscular into upper outer quadrant of the buttock.

  13. DRAW BACKS • 1.injections are painful • 2.chance of abscess formation • 3.discoloration of the skin over injection site. • 4.reactions like fever, headache , allergic reactions are few.

  14. Intra venous route – • Iron dextran compound , 1ml of which contains 50mg elemental iron . • Total dose infusion is calculated and given while admiting the patient for a day. Precautions are to be taken.

  15. advantages – • 1.it eliminates repeated and painful IM injections • 2.T/t is completed in a day and patient can be discharged much earlier • 3.it is less costly as compared to IM therapy . • 4.most suitable during 30-36 wk of pregnancy

  16. INTESTINAL WORMS- • Hookworms / roundworms are commonest intestinal infestations . • Diagnose by R/E stool . • Do deworming after first trimester .

  17. RENAL DISORDERS • There is increased chance of UTI in females as compare to males due to • 1.short urethra • 2.close proximity of the external urethral meatus to the areas ( vulva and lower third of vagina ) contaminated heavily with bacteria , catheterisation .

  18. INCIDENSE- pyelonephritis in pregnancy is upto 3 % • ETIOLOGY-more in primigravidae • -previous h/o UTI • -presence of bacteria • -abnormality in renal tract

  19. Organisms responsible are-E.coli(70%), • Klebsiella(10%),staphylococcus,enterobacter,and proteus.

  20. ACUTE PYELONEPHRITIS- • Clinical features- • Appears beyond 16 wk. • Involvement-bilateral,if unilateral-more in right side. • Cl.features are due to-endotoxemia- • Fever with chills/rigor • Acute pain over loins-radiating to groins • Nausea,vomiting,anorexia • Pulmonary oedema

  21. INVESTIGATIONS- • 1.R/E-urine complete ,C/S urine • 2.culture-blood • 3.serum creatinine • 4.serum electrolytes

  22. Effect on pregnancy- • 1.abortion • 2.preterm labour • 3.IUD • 4.Low birth weight baby.

  23. MANAGEMENT- • 1.I.V.fluids • 2.monitoring of urine output,temp.,B.P. • 3.i.v. antibiotics-cephalosporins,gentamicin,cefazoline till culture report comes. • Followed by oral therapy for 10 days.

  24. 4.repeat urine c/s after 2 wks. of antibiotic therapy. • 5.look for-urinary obstruction if pt.does not respond • 6.nitrofurantoin-100 mg daily till end of pregnancy to prevent recurrence.

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