Anemia in Pregnancy PDF
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This document is a comprehensive overview of anemia in pregnancy, covering physiological and pathological cases. It details classifications, compensatory mechanisms, severity levels, potential complications for both mother and fetus, preoperative assessments, goals of anesthesia, choice of anesthesia procedures, and monitoring. It touches on other conditions, like Amniotic Fluid Embolism (AFE), which is also briefly explained, and provides relevant information, including incidence and components.
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# Anemia in Pregnancy ## Introduction * Hb concentration of `<11g%` or HCT `<33%` in 1st and 3rd trimester * Hb concentration `<10.5g%` in 2nd trimester * Hb concentration `<10g%` at any time in pregnancy ## Classification 1. **Physiological Anemia in Pregnancy** * Hb `< 10g%` * RBC count ~3.2...
# Anemia in Pregnancy ## Introduction * Hb concentration of `<11g%` or HCT `<33%` in 1st and 3rd trimester * Hb concentration `<10.5g%` in 2nd trimester * Hb concentration `<10g%` at any time in pregnancy ## Classification 1. **Physiological Anemia in Pregnancy** * Hb `< 10g%` * RBC count ~3.2 million/mm³ * PCV 30% * Normal RBC morphology with central pallor on peripheral smear. 2. **Pathological Anemia in Pregnancy** * **Nutritional** * Iron * Folate * Vitamin B₁₂ * Proteins * **Hemorrhagic** * Acute: Antepartum hemorrhage * Chronic: Hookworm, hemorrhoids * **Bone marrow insufficiency** * Aplastic anemia * Radiation * Infection with parvovirus B₁₂ * Drugs (aspirin, indomethacin) * **Anemia of chronic disease** * Chronic renal failure * Neoplasms * Infections * Malaria * Hookworm * Tuberculosis * **Hereditary Anemia:** * Sickle cell disease * Thalassemia * Other hemoglobinopathies * Hereditary hemolytic anemia: spherocytosis ## Compensatory Mechanisms * Increased cardiac output * Reduced blood viscosity * Increased 2,3 DPG in RBC * Rightward shift of Oxygen Dissociation Curve (ODC) * Increased production of erythropoietin ## Severity of Anemia * Mild anemia: 10-10.9 g/dL * Moderate anemia: 7-9.9 g/dL * Severe anemia: `<7g/dL` ## Complications **Maternal Complications:** * Heart failure at 30-32 wks * Uterine atony, APH * Preeclampsia * PPH * Preterm labor * Infection **Fetal Complications:** * Low birth weight * Intrauterine death * Fetal acidosis ## Preoperative Assessment: * History of tiredness, fatigueability, breathlessness, palpitation, angina * Tachycardia, wide pulse pressure, ejection systolic murmur, pallor, crepts * **Investigations:** * Complete hemogram, reticulocyte count * Stool and urine analysis, ESR, serum creatinine, BUN, bilirubin * Serum proteins, iron, B₁₂ and folate levels, TIBC, Hb electrophoresis * ECG for evidence of MI * MCHC, MCV, MCH ## Goals of Anesthesia * Minimize factors affecting O₂ delivery * Prevent increase in O₂ consumption * Optimize PaO₂ in arterial blood ## Choice of Anesthesia * **Regional anesthesia preferred (SAB/CSE) as:** * Good analgesia * Ability to provide supplemental O₂ * Reduce blood loss * Reduce DVT * **Disadvantages of regional anesthesia:** * Hypotension and hemodilution * Chance of pulmonary edema due to overload * **Avoided in B₁₂ deficiency with CNS symptoms as it worsens subacute degeneration of cord** ## Monitoring * ECG, SpO₂, NIBP, E,CO₂, temperature, urine output * IBP, CVP in unstable patients * PA catheter and mixed venous oxygen saturation helpful # Amniotic Fluid Embolism ## Introduction * Catastrophic event * Fluid embolism of amniotic fluid enters the maternal circulation. * AF embolism is a rare obstetrical emergency with high * First reported case in 1941 * First described in 1953 * Also called amniotic fluid embolus syndrome * Also called aorto-pulmonary syndrome ## Incidence * Incidence of ~1 in 80,000 pregnancies. Ranges from 1 in 40,000 to 1 in 200,000. * Responsible for ~10% maternal mortality worldwide. * Maternal mortality rate reported in published studies ~10-80%. * In 1979 to 37, they reported a maternal mortality rate of ~25% * 25% of patients with this condition develop symptoms like respiratory distress. * Neonatal mortality rate is very high * Only 50% of patients with a diagnosis of AF embolism are actually intact ## Components of Amniotic Fluid: <br></br> Volume of amniotic fluid increases from ~4-15 ml at 12 weeks to ~1000 ml at term. **It is hypotonic:** * The damage is caused not by the volume but the contents of amniotic fluid. * pH = 6.9-7.4 * Suspended particles: * Lanugo * Hair meconium * Vernix caseosa * Nitrogenous material: * Amino acids * Urea creatinine ## Other things to note: * In the image, the text is partially cut off at the bottom * Some words are also not easily readable due to an unclear image. * This includes the text at the bottom of the first page and top of the third page, but this is not a crucial part of the paper * This document appears to be from a manual on obstetric anesthesia. * This is only part of a much larger document. * The paper also contains a variety of punctuation and formatting, which I have converted to markdown.
