Presentation on theme: "Anaemia in pregnancy Anaemia is one of the most common disorders affecting humans in the world. The WHO defines anaemia as Haemoglobin (Hb)< 11g/dl. Chronic."— Presentation transcript:
1Anaemia in pregnancyAnaemia is one of the most common disorders affecting humans in the world.The WHO defines anaemia as Haemoglobin (Hb)< 11g/dl.Chronic anaemia results in the sense of well-being; fatigue, stress, decrease in work capacity.Anaemia in pregnancy, is associated with an increased risk of maternal and fetal morbidity and mortality.
2Physiological changes in pregnancy Healthy pregnancy and puerperium are associated with a marked physiological changes in the circulating blood; increase in blood volume and alteration in the factors involved in haemostasis.These changes have relevance to the most potential and hazardous haematological problems of pregnancy& delivery.What are they???
3Physiological changes Blood volume;Plasma volumeRed blood massHypervolemia state, modifies the response to hypotension in the first half of pregnancy and the blood loss at delivery.Vaginal delivery;? mlCaesarean section? ml
4Causes Inadequate intake of nutrition Excess blood loss Abnormal demandmalabsorption
5Iron deficiency anaemia Hb concentration decreaseMCVMCHMCHCAll can be calculated from RBC, Hb,Packed cell volume.These tests give basic guide to a diagnosis in pregnancy.
6MCV, the most sensitive indicator of underlying Iron deficiency, decrease Hypochromia, and MCHC appear with more severe degree of Iron defiency.Serum ferritinTotal Iron binding capacity
7Management Confirm diagnosis; history, examination and investigation Treatment depends on the degree of anemeia and ?????
8Treatment Nutrition Iron therapy, various forms, depends on Compliance of the womanAssociated GIT symptomsAvailability of medicationCost
9Oral Iron,ferrous fumerate, ferrous sulphateDoes depends on level of HBSupplement folic acidGive proper instructionsCare if on throxine, calcium,
10Injectable/ parentral Iron therapy IntramuscularIntravenous infusion
11The following statements about oral iron prophylaxis during pregnancy are correct: Gastric side effects are does-related.Iron absorption during the first trimester of pregnancy is decreased compared with non-pregnant state.Non-compliance of the mother occurs in less than 10%.Oral maternal iron prophylaxis is recognized to be associated with an increase in MCV
12Iron deficiency anaemia in pregnancy MCHC and MCV are lowThere is usually chronic blood lossBlood transfusion is indicated if the Hb is <9gm/dl.There is increase risk of Pre-eclampsia.There is no proven danger of teratogencity from Iron therapy.
13A clinical scenarioA 25 years old gravida 2with a normal past obstetric history, is found to have a Hb of 10gm/dl at 32 weeks of gestation. The Hb at booking(12 weeks) was 12gm/dl and she has not taken Iron supplements during this pregnancy. Full investigation shows a MCH of 32 and a MCV of 86FL. The blood film shows some polychromasia and microcystic.
14These findings are diagnostic of Iron deficiency anaemia The MCV is a better guide to the presence of Iron deficiency anaema than is Hb level.Should iron deficiency occur late in a prgnancy, parentral Iron will raise the hb faster than oral iron
15Haemoglobinpathies Sickle cell disease Is the name given to a group of inherited blood conditions which include:Sickle cell anaemia,Sickle cell beta thalasemia,Haemoglobin SC disease.The most common and severe is Sickle cell anaemia
16What causes sickle cell anaemia Inherited disorder of the Hb structure
17Antenatal careSickle cell trait (HbSA) , may have UTI and microscpic haematuria’Sicle cell anameiaBad obstetric historyPainful crisesJaundiceAnaemiaDeformed pelvis Increase rate of operative deliveries; CSavascular necrosis of the hip
18Diagnosis Hb electrophoresis, not specific, Hb D, G Sickling test, not specific, HbC Hb memphis.Hb solubility test, specific, cheap, rapid and simple.reticulocytes
24Treatment Multi-disciplenary approach Supportive measures Rehydration AnalgesicsBlood transfusion, keep Hb S level<40%Keep Hb A level >60%
25Further ReadingsManagement of sickle cell Disease in pregnancy.Guideline No 61 July 2011
26Maternal sickle cell disease The spontaneous miscarriage is increasedThe incidence of proteinuric hypertension increased.The incidence of spontaneous delivery is increased.The incidence of small for gestational age is unchanged.The presence of sickle cell disease in the fetus can not be diagnosed.
27Sickle cell diseaseThere is failure of formation of the beta chain of polypeptide.Hb level rarely fall below 9gm/dl.Iron deficiency anaemia is usualCrises is unlikely to occur the trait.