1. ANAEMIA IN PREGNANCY
AHMED ABDULWAHAB

2. It is the commonest medical disorder of pregnancy.
Physiological changes.
Plasma volume increase by 50%.
Red cell mass increase by 25%.
Fall in Hb concentration and haematocrit due to haemodilution.
MCV increase secondary to erythropoiesis.

3. Cont,
MCHC remain stable.
Serum iron and ferritin decrease because of utilization .
Total iron binding capacity increases TIBC
Iron requirement increases total of 1000mg in whole pregnancy.
Moderate increase in iron absorption .
Folate requirement increases

4. DEFINTION..
WHO recommended that Hb concentration should fall below 11gm/dl in pregnancy to diagnose anemia.
Incidence 30-50% pregnant women are having anemia at pregnancy.
90% have iron deficiency anemia .
5% folate deficiency .

5. CLINICAL FEATURE.
Often asymptomatic.
Diagnosed in routine screening .
Other ,tiredness, dizziness ,fainting , pallor may be apparent

6. SCREENING .
Routine screened by Hb concentration at the beginning of pregnancy .
It is cheep and simple..
It does not reveal the cause .

7. IRON DEFICENCY ANAEMIA .
It is microcytic hypochromic . Reduced MCV . MCHC.
Etiology .
Increase demand in pregnancy due to expanding red cell mass, fetal requirement .If iron stores are depleted because of menstruation , recurrent pregnancy ,poor intake , anemia develops rapidly

8. CONSEQUENCES .
Preterm labor.
Infection
Medical intervention during labor .
Post partum blood loss.
? IUGR.

9. TREATMENT.
Oral iron is effective when there is time .
Hb increase 0.8 g/dl per week
Ferrous salt is better absorbed than the ferric form .
Side effect depends on the amount of the of the elemental iron .
Choice depends on cost and patient tolerance .

10. Cont.
Vitamin –C helps absorption .
Main side effect are gastro intestinal , gastric upset and constipation .
Indication for parenteral thereby .
Lack of compliance , severe GIT side effect, mal absorption
Intera muscular iron sorbitol

11. Cont.
Deep im it is painful cause discoloration of the skin .
High level may be excreted before utilization .
IV IRON .
Iron saccharate cause more rapid rise in Hb and has fewer side effect. Compared

12. Cont
To oral iron but more invasive , need admission to hospital , it is true alternative to blood transfusion.
Blood transfusion ,
Most rapid way to increase the Hb .
Used when there is no time to correct anemia .
Risks include allergy and transmission of infection

13. Cont.
Prevention is possible with good balanced diet .
Identification and treatment of iron deficiency prior to pregnancy are optimal .
Routine iron supplementation in pregnancy improve in hematological indices.