Obstetrics & Gynaecology Anemia in Pregnancy PDF

# Obstetrics & Gynaecology ## Group 6 ## Topic: Anaemia in Pregnancy ## BSC. NURS L400 REGULAR - Anaemia is a condition in which the number of red blood cells or hemoglobin levels is insufficient to meet the physiological needs of the individual, which consequently varies by age, sex, altitude,...

# Obstetrics & Gynaecology ## Group 6 ## Topic: Anaemia in Pregnancy ## BSC. NURS L400 REGULAR - Anaemia is a condition in which the number of red blood cells or hemoglobin levels is insufficient to meet the physiological needs of the individual, which consequently varies by age, sex, altitude, smoking, and pregnancy status (WHO, 2013). ## Anemia in Pregnancy - WHO defines Anaemia in pregnancy as the haemoglobin (hb) concentration of less than 11g/dl in the first and third trimester and 10.5g/dl in the second trimester. ## Types of Anemia in Pregnancy - **Iron-Deficiency Anemia**: This is the most common type of anemia during pregnancy. It occurs when there is insufficient iron to produce hemoglobin, the protein in red blood cells that carries oxygen. Pregnant women need more iron to support increased blood volume and fetal development. - **Folate-Deficiency Anemia**: Folate (vitamin B9) is essential for red blood cell production. A deficiency in folate can result in megaloblastic anemia, where red blood cells are larger than normal and not fully functional. Folate supplementation is recommended during pregnancy. - **Vitamin B12 Deficiency Anemia**: Vitamin B12 is also vital for red blood cell production. A deficiency in B12 can lead to megaloblastic anemia, similar to folate deficiency. This is less common but may occur in women with a vegan diet or malabsorption issues. - **Anemia of Chronic Disease**: This type is typically associated with underlying chronic conditions such as infections, inflammatory diseases, or chronic kidney disease. It's less common in pregnancy but may still occur in certain cases. - **Sickle Cell Anemia**: This is a hereditary condition where red blood cells are sickle-shaped and cannot carry oxygen efficiently. Pregnancy can exacerbate symptoms, and women with sickle cell disease require special monitoring. - **Thalassemia**: This is another hereditary blood disorder that affects hemoglobin production. In pregnancy, it can cause mild to moderate anemia. Thalassemia carriers might not have symptoms, but the condition can be more pronounced in pregnancy. - **Hemolytic Anemia**: This can occur if the body destroys red blood cells faster than they can be produced. It can be due to autoimmune conditions, infections, or certain medications ## Causes - **Iron Deficiency**: The body's iron requirements increase during pregnancy due to the expansion of blood volume and the growing fetus. Insufficient iron intake or poor absorption can lead to iron-deficiency anemia. - **Folate Deficiency**: Folate (vitamin B9) is essential for red blood cell production. Inadequate intake of folate-rich foods or poor absorption can cause megaloblastic anemia, a type of anemia characterized by large, immature red blood cells. - **Vitamin B12 Deficiency**: Like folate, vitamin B12 is necessary for the production of red blood cells. A deficiency can lead to anemia, though it's less common in pregnancy than iron or folate deficiency. - **Increased Blood Volume**: Pregnancy increases blood volume, which can dilute the blood, making it seem like there are fewer red blood cells (this is known as "physiological anemia" or "hemodilution"). - **Chronic Conditions**: Pre-existing health conditions, such as sickle cell disease, thalassemia, or chronic kidney disease, can increase the risk of anemia during pregnancy. ## Risk Factors for Anemia During Pregnancy - **Nutritional Deficiencies**: Insufficient intake of iron, folate, and vitamin B12. - **Young Maternal Age**: Pregnant teenagers are at higher risk. - **Multiple Pregnancies**: Carrying twins or more increases iron demands. - **Short Intervals Between Pregnancies**: Close successive pregnancies can deplete iron stores. - **Low Socioeconomic Status**: Limited access to nutritious food and healthcare. - **Non-compliance with Supplements**: Failure to take prescribed iron supplements. - **Chronic Illnesses**: Conditions like intestinal parasites can exacerbate anemia. ## Signs and Symptoms - Fatigue - Paleness (Pallor) - Shortness of Breath - Dizziness or Lightheadedness - Cold Hands and Feet - Reduced Exercise Tolerance - Trouble concentrating ## Diagnostic Investigations The diagnostic investigation involves clinical evaluation and laboratory tests to determine the type and cause of anemia. ### 1. Clinical Assessment - History - Symptoms - Dietary history - Chronic diseases - Obstetric history - Physical Examination ### 2. Laboratory Investigations - Laboratory investigations for anemia in pregnancy primarily involve a Complete Blood Count (CBC), which evaluate: - Red Blood Cell Count (RBC) - Hemoglobin (Hb) - Hematocrit (Hct) - Mean Corpuscular Volume (MCV) - Mean Corpuscular Hemoglobin (MCH) - Mean Corpuscular Hemoglobin Concentration (MCHC) - **Additional Tests for Specific Causes**: Depending on clinical suspicion, further tests may be necessary: - Hemoglobin Electrophoresis - Urine or Stool Tests - Coombs Test (Direct Antiglobulin Test) - Ultrasound/Endoscopy ## WHO Recommendations - **Iron supplementation**: For iron deficiency anemia, the WHO recommends oral iron as the first line of treatment. The recommended dose is 30mg- 60 mg of elemental iron daily. In regions where anaemia prevalence is particularly high (greater than 40%), higher doses may be recommended up to 60mg per day. - **Folic acid supplementation**: The WHO recommends starting folic acid as early as possible, ideally before conception, to prevent neural tube defects. Pregnant women should receive 400 µg of folic acid daily starting before conception and continuing during the first trimester to reduce the risk of neural tube defects and prevent folate-deficiency anemia and support overall fetal development. - **Screening**: The WHO recommends screening for anemia at the first prenatal visit, between 24 and 28 weeks, and at 36 weeks. - **Follow-up Testing**: Additional haemoglobin testing may be necessary, especially in the second and third trimesters, to monitor for the development of anaemia. - **Malaria**: Malaria can contribute to anemia, so the WHO recommends the use of intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine in areas with high malaria transmission. - **Vitamin B12 supplementation**: The WHO recommends vitamin B12 supplementation (usually 1000 µg per day orally or 1000 µg intramuscular injection weekly until levels normalize). ## Management of Anaemia is Pregnancy - **Dietary Recommendation**: Pregnant women are encouraged to consume a diet rich in iron, folate, and B12 to naturally boost their nutrient levels. Foods high in iron include lean meats, leafy green vegetables, beans, lentils, and iron-fortified cereals. These foods are best paired with vitamin C-rich items like citrus fruits and bell peppers, as vitamin C enhances iron absorption. ## Treatment - **Iron Supplementation**: This includes oral and intravenous medication. - **Oral Iron Supplements**: Most pregnant women with mild to moderate iron deficiency anemia can be treated with oral iron supplements (e.g., ferrous sulfate or ferrous gluconate). It's usually recommended to take these on an empty stomach or with vitamin C to improve absorption. - **Intravenous (IV) Iron**: In cases where oral iron isn't tolerated and the anemia is more severe, IV iron may be used. - **Dosage**: Typically, pregnant women are advised to take 30-60 mg of elemental iron per day. - **Timing**: It's usually recommended to take iron on an empty stomach for better absorption, although it can be taken with food if gastrointestinal side effects occur (e.g., nausea, constipation). - **Side Effects**: Iron supplements can cause constipation, nausea, or stomach discomfort. - **Folate supplementation** is also crucial in managing anemia during pregnancy, as folate is an essential nutrient for red blood cell formation. - **Education and Counseling**: Educating pregnant women about the importance of nutrition, iron supplementation, and recognizing symptoms of anemia (such as fatigue, weakness, and pallor) is crucial for prevention and early intervention. - **Monitoring and Follow-up**: Routine blood tests (e.g., hemoglobin levels, iron studies allow healthcare providers to track hemoglobin levels and adjust treatment as necessary. - **Postpartum Care**: Monitor women for anaemia in the postpartum period. Women who experience significant blood loss during delivery are at higher risk for anemia. Postpartum care should include screening and treatment if needed. ## Complications - **Maternal Risks**: - Preterm delivery - Placental abruption - Severe postpartum hemorrhage - Increased risk of maternal mortality and ICU admission. - **Fetal Risks**: - Low birth weight - Stillbirth - Fetal growth restriction - Developmental delays ## Thanks for your attention! ## List of Members with Indexes - **KYEI-BAFFOUR GODBLESS - PU/211170** - **NABO ABIGAIL PU/211288** - **DZORDZI PRISCILLA - PU/210935** - **IRENE APPIAH - PU/A210746 ** - **BRIDGET AGYAPOMAA AGYEKUM - PU/210503** - **KINGSFORD YAWSON - PU/210740** - **JOSEPH ADU - PU211335.** - **JOSEPHINE AMOAH PU/211127** - **ESTHER AMOAH - PU/210994**