Anaemia in pregnancy
Anemia is one of the common problem during pregnancy. It is very important to remember that even a small bleeding will cause life threatening to the anemic mother. It may predisposes to infection. It may also worsen a heart failure where the patient might end up with angina due to low haemoglobin level.
WHO Definition of anemia is where Hb <11g/dL. By this standard, 50% of pregnant ladies that has not taken haematinics (iron tablets) will become anaemic. The fall of haemoglobin is more severe around 20 weeks gestation and it may cause low birth weight baby or even contribute to premature delivery.
There are a lot of factors that contribute to this condition. Those who is already anemic before pregnancy most likely to be anemia during pregnancy. This usually involves those women who has menorrhagia (heavy vagina bleeding) and malaria. Hookworm and haemoglobinopathies are also very common cause of anemia. Other risk factors include frequent pregnancies, twin pregnancies and poor nutrition intake (this will usually cause iron deficiency anaemia).
Antenatally, the paramedics will screen every women at their first booking of antenatal check up. After that, if patient’s haemoglobin is normal, they might repeat the Haemoglobin count at 28 and 36 weeks. In black patients, it will be wise to check for sickle cell tests where sickle cell disease is common in this group of people. Sickle cell disease is an inherited disorder that leads to the production of an abnormal hemoglobin variant of hemoglobin S (HbS or HgbS). In others of foreign descent Hb electrophoresis will be done in evidence of anaemia to look for haemoglobinopathies like thalassaemia trait. In certain areas where common to have malaria, thick films for malaria should be considered.
Most cases usually will be treated by taking iron supplement by 700-1400mg (per pregnancy) Iron tablet will be supplied to people who shows sign of iron deficiency and who is likely to refuse blood transfusion should hemorrhage occur. For those women who is unable to tolerate iron tablet, parenteral iron is indicated. However, in this type of therapy, it usually takes up to 6 weeks ti increase the haemoglobin level, so, in late severe anemia which Haemoglobin <9g/dL, blood transfusion is needed. Each unit may increase haemoglobin by 0.7g/dL.
Reference:
- Oxford Handbook of clinical specialties. 5th edition.2001.
- http://www.labtestsonline.org/understanding/analytes/sickle/glance.html
Tags: anemia, haemoglobinopathies, hookworm, low birth weight, malaria, pregnancyy, twin pregnancy
Technorati Tags: anemia, haemoglobinopathies, hookworm, low birth weight, malaria, pregnancyy, twin pregnancy
Having iron capsules causes constipation in some people. Which is terrible in pregnancy.
thanx
In certain areas where common to have malaria, thick films for malaria should be considered.