Anaemia in Pregnancy

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It is hemoglobin levels less than 11 g/dl in early pregnancy and less than 10.5 g/dl in the 2nd and  3rd trimester of pregnancy. Mild anemia– hemoglobin: 8–11g/dl; Severe anemia– hemoglobin<7g/dl.  Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth  weight, preterm delivery and perinatal mortality. 

Clinical presentation 

  • Tiredness, weakness, palpitations and dyspnea  
  • Exercise intolerance  
  • Pallor of skin and mucous membranes  
  • Dizziness, faintness, headache  
  • Intermittent claudication (ache, cramp, numbness or sense of fatigue)  

Note: Some patients with anaemia in pregnancy may be asymptomatic 

Investigations   

  • Full blood count and blood cross-match - red cell morphology 
  • Red blood cell electrophoresis if haemoglobinopathies suspected 
  • Blood smear for malaria  
  • Stool and urine analysis  
  • HIV test 

Non-pharmacological Treatment   

  • Iron rich diet (fish, eggs, fruits and vegetables etc.)  
  • Prevent and early treatment of malaria  
  • Investigate and treat associated worm infestations  

Pharmacological Treatment  

Prophylaxis in Antenatal Care 

A: ferrous sulfate(PO) 200mg 8-12hourly 

AND    

A: folic acid (PO) 5mg 24hourly 

Note:  Ferrous sulfate should be taken in a full stomach and avoid taking it with tea/coffee           Where vomiting is experienced reduce dosage to tolerable level 

If Hb is <7g/dl in 1st and second trimester give:   

A: ferrous sulphate + folic acid (FDC) (PO) 1 tab 12hourly for 4 weeks. 

AND  

A: vitamin B (PO) 12hourly for 4 weeks  

If HB is ˂7g/dl in 3rd trimester or in case of signs for severe anaemia (features of heart failure)  

  • Refer/admit the patient for blood transfusion at least 2 units of Packed RBCs 
  • Continue with ferrous and folic acid as above after blood transfusion