HEALTH PRESENTAION LOOKING AT ANAEMIA IN PREGNANCY

1. ANAEMIA IN
PREGNANCY
BY Mr. M. MWANSA
RN, RNM, Bsc-NRS

2. Outline
•Introduction
•Objectives
•Definition
•Causes
•Signs and symptoms
•Effects of anaemia in pregnancy
•Prevention of anaemia in pregnancy

3. Introduction
•Majority of pregnant women in developing
countries are grossly anaemic.
•Anaemia in pregnancy is related to most
common complication in pregnancy and labour.
• Estimated prevalence according to WHO
Developed countries -18% Developing countries
56% In Africa the prevalence is 50-60%
Anaemia

4. Specific Objectives
Define Anaemia
• State the causes and predisposing factors of anaemia in
Pregnancy
• Discuss pathophysiology of anaemia in pregnancy
• State the signs and symptoms of Anaemia in pregnancy
• State the effects of Anaemia in pregnancy
• Describe the management of Anaemia in pregnancy
• Discuss prevention of Anaemia in pregnancy

5. Definition
•Anaemia is a reduction in the oxygen carrying
capacity of the blood; this may be caused by
decrease in red blood cell production, or
reduction in haemoglobin count of blood or a
combination of both (Myles, 2003).
•Anaemia refers to a state in which the levels of
heamoglobin (Hb) in the blood is below the
normal range appropriate for the age and
sex(Alastair,2009).

6. CLASSIFICATION OF ANAEMIA
Anaemia is classified as;
• Iron deficiency anaemia
• Folic acid deficiency anaemia – megaloblastic
• Haemoglobinopathies- i.e. Sickle cell anaemia and
thalassemia.
• Anaemia due to blood loss and/or secondary to
infection and haemolysis
• Aplastic anaemia

7. CLASSIFICATION OF ANAEMIA
1. Iron deficiencyIn pregnancy there always an increased
demand for iron which is not always met. This can be
due to inadequate dietary intake of iron or impairement
in the absorbtion of iron in the GIT.
2. Folic acid deficiency-Folic acid is not stored in the
body therefore; the body’s needs must constantly be met
through dietary intake. Deficiency of folic acid causes a
form of megaloblastic anaemia identical to that seen in
vitamin B12 deficiency, but not associated with
neurological damage

8. CLASSIFICATION CONT’’
3. Aplastic anaemia
• Aplastic (hypo plastic) anaemia results from bone marrow failure
in which there is reduced number of erythrocyte.
• Since the bone marrow also produces leukocytes and platelets,
leukocytopenia (low white blood cells) and thrombocytopenia
(low platelet count) are likely occur.
4. Haemolytic anaemia.It occurs when circulating red blood cells
are destroyed or are removed prematurely from the circulation
because the cells are abnormal or the spleen is overactive

9. CLASSIFICATION CONT’’
• Sickle cell anaemia – It is an inherited condition in which there
is abnormal haemoglobin “S” in the red blood cells. Blacks are
more affected
• Thalassemia – there is reduced globin synthesis which results in
reduced haemoglobin production and increased fragility of the
cell membrane, leading to early haemolysis
• Haemorrhagic anaemia- due to acute or chronic bleeding

10. PREDISPOSING FACTORS
 Dietary insufficiency- a diet which is low in iron, vitamin C and
protein. This can be due to poverty or poor eating habits,
customs and poor preparation of food will eventually lead to
anaemia.
 VEGANS- much of the iron which is taken in is bound and not
easily released in vegetarian diets, therefore these women often
suffer from anaemia.
 PICA- Certain clays sometimes consumed by pregnant women
absorb iron, causing or increasing anaemia. Strangely, PICA is
also a symptom of iron deficiency

11. PREDISPOSING FACTORS CONT..
 The grand multiparous- When there are frequent and recurring
pregnancies, with no enough nutrients in a diet, pregnancy
deprivation syndrome occurs
 Worm infestation- some worms release toxins that suppress the
normal function of the bone marrow. Worms such as hook
worms and wipe worms use up the nutrients from the diet for its
own growth, hence deprive the host of the essential nutrients
 Infections like Malaria may cause haemolytic anaemia.
 Haemorrhoids- may bleed and cause haemorrhagic anaemia
 Medication or drugs- substances such as anti-epileptic agents,
anti-coagulants and some oral antibiotics.

12. CAUSES
1. Increased demand due to pregnancy
This is the most common cause of Anaemia in
pregnancy. The fetus takes about 300mg of iron
from the mother A further 700mg is needed by
mother’s own expanded blood volume, the
placenta, and the growing uterine muscles

13. CAUSES CONT”
•Total iron during pregnancy requirement is
about 1000mg.
•450mg for expansion of maternal RBC mass and
increased blood volume
•300mg for the foetus
•50gm for placenta
•200mg for maternal basal loss

14. Causes
2. Deficient intake of iron, VitB12 & Folic acid
•To manufacture normal red blood cells the body
requires protein, iron, folic acid, and vitamin
B12. Deficiency can be due to;
•Lack of the right food or inadequate food
•Poor appetite of the pregnant woman
•Malabsorption due to chronic diarrhea

15. CAUSES CONT’’
• 3. Reduced absorption of iron as a result of gastro intestinal
disturbances (diarrhoea and vomiting) or increase in the
intake of alkalis to reduce heart burn which discourages iron
absorption.

16. 4. Acute or chronic blood loss
•Women embark on a pregnancy when already
iron depleted. In some studies 50% of the non
pregnant women in reproductive age are anaemic
•This might be because of heavy menstrual flows
or bleeding in past pregnancies. These past
pregnancies, which very often follow each other
very closely
•Might have been complicated by antepartum or
or hemorrhoid's which will cause further loss

17. Causes Cont’
5. Increased red cell destruction
When red cells grow old (120days), they are
destroyed in the spleen and the liver. Destruction is
accelerated when the oxygen in the blood is low.
This leads to lower, oxygen concentration in the
blood and cell destruction is increased.
Infection with falciparum malaria also leads to
destruction and haemolysis of the red cells

18. GRADING OF ANAEMIA IN PREGNANCY
 No anaemia: -this is when the Hb is equal or more than
11g/dl
 Moderate anaemia: -this is diagnosed when the Hb is
greater or equal to 7g/dl and less than 11g/dl.
 Severe anaemia: -is diagnosed when the Hb is less than
7g/dl

19. PATHOPHYSIOLOGY OF ANAEMIA IN PREG
• Anaemia occurs when the rate of production of mature red
blood cells(RBC) entering the blood from the red bone marrow
does not keep pace with the rate of haemolysis or body
requirement.
• The normal range of haemoglobin in the non gravid female is
12-14g/100ml, during pregnancy, it should not go below 12g/dl.
• According to WHO, Anaemia is diagnosed when the pregnant
mother has haemoglobin level below 11g/dl in the 1st trimester
or lower than 10.5g/dl in the 2nd trimester.

20. PATHOPHYSIOLOGY CONT’’
• During pregnancy more iron, Folic acid and Vit B12
are required for the extra haemoglobin in the
increased blood volume of 45%, although the red cells
only increase by 25%. This phenomenon is known as
the hydraemia of pregnancy.
• This is the dilution of blood and thereby making it less
viscid.
• The reduced viscosity of the blood helps to increase
the cardiac output and makes the perfusion of the
placental bed easier.

21. PATHOPHYSIOLOGY CONT’’
• However, the dilution of the blood will also decrease the
haemoglobin concentration in the blood. During pregnancy,
maximum blood dilution occurs at 30weeks.
• This leads to inaquate oxygen capacity leading to placenta and
tissue hypoxia.
• As a result, the mother will feel dizziness, tired easily, pallor,
Tarchycardia and difficulties in breathing.
• Complications like abortion, IUGR, fetal and maternal distress
may occur.

22. Signs and symptom’s
•Fatigue- due to reduced Hb and oxygen as a
result of reduced metabolism.
•Breathlessness- is evident even on the slight
exertion due to reduced tissue oxygen supply.
•Pallor of the mucous membranes, nail beds and
skin due to reduced RBCs in the periphery

23. Signs and symptom’s cont..
•Tachycardia and palpitations as the heart tries
to compensate by palpitations and wide pulse
pressure with ejection murmurs.
•Oedema of the ankles/lower limbs as a result of
renal hypoxia. This results in increased sodium
retention and consequently water retention.
•Cardiac failure and Angina in extreme cases
due myocardial hypoxia

24. Effects of anaemia in pregnancy
On the mother
•Maternal distress: Cause reduced maternal ability
to withstand the rigors of labour, giving rise to
maternal distress, followed by shock and
collapse.
•Poor prognosis of labour leading to complicated
assisted deliveries.

25. Effects of anaemia in pregnancy cont..
•Causes poor lactation due to reduced oxygen
supply leading to reduced metabolism
•Postpartum haemorrhage due to reduced platelet
count and increased incidence of uterine atony
on all stages of labour
•Increase chances of abortions: due to placenta
hypoxia

26. Effects of anaemia in pregnancy cont..
On the Fetus and Neonate
•Intra uterine growth restriction (IUGR): as a
result of chronic uterine hypoxia and inadequate
nutrients to the foetus
•Intra uterine fetal death(IUFD) due to insufficient
nutrients and oxygen
•Neuro tube defect of spinal bifida due to lack of
iron and folic acid.

27. Effects of anaemia in pregnancy cont..
•Fetal distress due to insufficient oxygen.
•Asphyxia due to placental hypoxia leading to
fetal distress.
•Low birth weight as a result of reduced nutrient
supply to the fetus.
•Prematurity due to reduced oxygen and
nutrient supply to the fetus

28. Management
History taking
•Will reveal the following: age, parity, occupation
and home condition.
•Previous pregnancies-spacing of children, date of
last pregnancy and how long she breastfed
Complications and mode of delivery

29. Management cont…
•Present pregnancy any complications like
varicosities, ante partum hemorrhage.
•Availability food
•It will also reveal previous illness such as
malaria, bilharzia and worms
•History of fatigue and general body pains

30. Management cont…
Investigation
•Blood for FBC will review a low Hb
•Bone marrow biopsy obtained from the sternum
or iliac crest in severe cases.
•Stool exam. To rule out ova in worm infestation
•Urine for microscopic culture and sensitivity to
rule out urinary tract infections

31. Management cont…
•Sickling test to rule out sickle cell disease.
•Blood slide for malaria parasites to rule out
malaria
Drug therapy
•Ferrous sulphate 200mg TDS
•Folic Acid 5mg once daily

32. Management cont…
•Fansida 3 tablets stat for malaria prophylaxis
•Mebendazole 500mg per oral stat
•Blood transfusion: whole blood or packed cells
in severe cases

33. Management cont…
NURSING CARE
•Aims of care
•Prevent complications
•prolong the pregnancy until the foetus is mature
and delivered alive and health.

34. MGT cont’
Labour
Together with the standard nursing care of a woman in labour, the
following specific care is given;
 Intravenous therapy must be erected but the patient the patient must
not be over hydrated and pulmonary oedema must be watched for.
 Blood is taken for compatibility in case of need, particularly if the
anaemia if severe.
 Avoid episiotomies and excessive blood loss
 These patients have very poor anaesthetic risk therefore; operative
procedures should be avoided if possible

35. MGT cont’
Third stage of labour
 Third stage of labour must be actively managed, that is the
administration of I.M or IV syntometrine given to control
possible haemorrhage.
 The placenta must be expelled by controlled cord traction
(C.C.T) method.
 Syntocinon 5iu I.V and 5iu I.M can be given as an alternative
regimen and these oxytocic’s are given on doctor’ order

36. Management cont…
Psychological care
•Reassure the mother about her condition, explain
the investigations and treatment being given to
relieve anxiety.
•Explain and involve the caretaker in the care of
the patient

37. Management cont…
•Rest/Environment
•Complete bed rest in order to prolong pregnancy
•Provide a firm mattress for comfort
•Clean and well ventilated room to enable woman
to rest well.

38. Management cont…
•Clean and well ventilated room to enable woman
to rest well.
•Organize nursing activities in blocks in order to
allow patient to rest.
•Keep oxygen cylinder and other emergence drugs
within reach for use in case of an emergence

39. Management cont…
Position
•Prop up patient in bed for easy breathing and
lung expansion
•Encourage patient to lie on her side as supine
position can aggravate supine hypotensive
syndrome

40. Management cont…
Hygiene
•Assisted baths or bed baths are given to
promote patient’s comfort.
•Encourage oral toilet to stimulate appetite and
prevent oral infections.
•Do pressure area care to promote blood supply
and prevent sores.

41. NSG MGT CONT’’
•Encourage woman to wash hands after toilet or
after changing pads to prevent infection
Nutrition
•Encourage foods rich in iron e.g. green leafy
vegetables to boost the Hb
•Provide a diet rich in protein to boost the
immunity, and roughage to prevent constipation.

42. Management cont…
Observations;
•Do observations of vital signs, A rise in vital
signs will indicate impending cardiac failure.
•Breathlessness and disturbing cough is due to
pulmonary congestion, reduced Blood Pressure is
due to reduced Hb

43. Management cont…
•Breathlessness and disturbing cough is due to
pulmonary congestion, reduced Blood Pressure is
due to reduced Hb.
• Record intake and output of fluids
•Provide kick chart to woman to record in order to
monitor fetal wellbeing.

44. Management cont…
•Monitor fetal wellbeing, contractions, abnormal
vaginal discharge and rupture of membranes
•Monitor for maternal and fetal distress
Exercise
•Encourage minimal exercises to prevent deep
vein thrombosis and stress on the heart.

45. Prevention of Anaemia in pregnancy
•Encourage a diet rich in folic acid and iron green
leafy vegetable.
•Advise not to overcook vegetables in order to
preserve their iron content.
•To eat foods rich in vitamin C for the absorption
of iron like oranges.

46. COMPLICATIONS OF MALARIA IN PREGNANCY
• Abortion
• Maternal distress
• Post partum haemorrhage
• Intra uterine growth restriction
• Fetal distress
• Intra uterine fetal death

47. Prevention cont….
•Give tablets of Ferrous Sulphate and folic acid to
boost the Hb levels.
•Provide Malaria prophylaxis, Fansidar 3 tablets
stat x 3 doses.
•Sleep under ITN to prevent mosquito bites.
•Routine Hb check for women in first and third
trimester at antenatal clinic.

48. Prevention cont….
•Encourage the mother to practice child spacing
so that there is time between each pregnancy for
her to replenish her body resources.
•Educate the community on proper disposal of
faeces to avoid hookworm infestation.
• Prevent or treat antepartum and postpartum
haemorrhage adequately

49. Prevention cont….
•Treat all infections and infestations such as
dysentery, bilharzia and hookworms.
•Give the following supplements to each woman
throughout the pregnancy
Ferrous sulphate 200 mg three times a day
Folic acid 5 mg daily.
Give Fansidar after sixteen weeks of gestation
period and continue every fourth week (three
doses

50. Prevention cont…
•Reduce hookworm by deworming all pregnant
women.
•Detect the Anaemia early and give adequate
treatment.
•Encourage mothers to sleep under mosquito net

51. CHAPWA!!
THANKYOU FOR YOUR ATTENTION
SHIMWANSA