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. 1.tiredness / weakness Loss of appetite 3.indigestion 4.palpitation
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 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. 1.it eliminates repeated and painful IM injections
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 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,a nd 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.