Anemia is common during pregnancy, affecting 37% of women in Jordan. It can cause complications for both mother and baby. The most common types are iron deficiency anemia and folic acid deficiency anemia. Key steps in managing anemia in pregnancy include screening all pregnant women, supplementing with iron and folic acid, treating identified cases, and educating women about nutrition. Treatment may involve oral or intravenous iron, blood transfusions, and managing underlying conditions like sickle cell anemia. Close monitoring is needed throughout pregnancy and delivery.
2. Definition
Is defined as a haemoglobin concentration less than
10.5gm /dl , or if hematocrit falls to less than 30%.( WHO)
Problem in the Jordan
Anemia during pregnancy and breast feeding is 37%.
23%-24% have mild anemia , 13.5% have moderate ,1% have
sever anaemia.
Degree: Mild: 8-10gm%Degree: Mild: 8-10gm%
Moderate: 7-8gm%Moderate: 7-8gm%
Severe: <7gm%Severe: <7gm%
According to UNICEF its found that more than 28% of women
of child bearing age were anaemic in Jordan.
3. Causes and predisposing factors:
1- low iron intake
low intake of iron-rich food
nausea and vomiting
2- Increased demand
heavy mens
High parity
bleeding haemorrhoids
3- Inadequate absorption /utilization of iron
food that have a strong inhibiting effect on iron absorption , tea ,
coffee, egg, ca++ rich foods.
Malabsorption syndrome.
Decreased HCL.
4. 4- increased iron requirements:
Increased demand from growing fetus , placenta.
Low internal between 1st
and 2nd
pregnancy
Effects of anemia on pregnancy :
Maternal :
abruptio placenta may be associated with maternal anaemia.
high risk for PPH.
High risk for infection puerperal sepsis.
Poor lactation is often a consequence of anaemia.
High risk of developing shock and death if Hge occur during
child birth (potential threat to life) .
Reduced enjoyment of pregnancy and mother hood of to
fatigue.
5. Fetal :
- increased of still birth neonatal deaths if
maternal Hb% decreased 8%.
-Increased incidence of pre-term labour.
-increased incidence of IUGR and hypoxia
** Note : the most common forms of anemia
are caused by deficiencies in iron and folic
acid.
6. Nurse role in the assessment of
women with anemia in pregnancy
History taking: hx of any of the predisposing
factors.
symptoms of anemia :
C.V.S palpitation.
C.N.S headache , visual disturbance , weakness ,
fatigability , drowsiness.
R.S breathlessness.
G.I.S anorexia , nausea , vomiting.
G.U.S loss of libido.
8. Physical exam :
General exam pallor of the skin and mucous of
membrane , tachycardia, tiredness.
Abdominal exam fundal height : less than the
gestational age
Investigations :
Laboratory investigation
CBC and RBC
HB < 10.5 gm/dl.
RBC concentration < 5x10^6 /mm^3
hypochromic & microcytic.
9. Normal Iron Requirements
Iron requirement for normal pregnancy is 1gm
200 mg is excreted
300 mg is transferred to fetus
500 mg is need for mother
Total volume of RBC inc is 450 ml
1 ml of RBCs contains 1.1 mg of iron
450 ml X 1.1 mg/ml = 500 mg
Daily average is 6-7 mg/day
10. Blood film.
Reticulocytic count.
Serous ferritin level.
Ultrasound to check gestational age ,
placental site , amount of liqour & any
congenital fetal malformation.
11. Normal hemoglobin by gestational age inNormal hemoglobin by gestational age in
pregnant women taking iron supplementpregnant women taking iron supplement
12 wks12 wks 12.2 [11.0-13.4]12.2 [11.0-13.4]
24wks24wks 11.6 [10.6-12.8]11.6 [10.6-12.8]
40 wks40 wks 12.6 [11.2-13.6]12.6 [11.2-13.6]
12. Intervention in pregnant women with
anemia
Prophylactic
Importance of antenatal visits
Encourage to attend the scheduled antenatal visit and explain
the importance of preventing & treating anemia in pregnancy.
Educate the mother regarding the sources of food rich in iron &
folic acid , sea food , fruit , meat, egg , green vegetables.
Advice to avoid poor eating habits & intake of enhancers of iron
absorption such as fruit , vegetables , vit C
Iron supplementation is very important during pregnancy & it
should be emphasized on all antenatal visits.
13. TreatmentTreatment
Prophylactic: Supplement Fe – 60 mg: Supplement Fe – 60 mg
elemental Fe with Folic Acidelemental Fe with Folic Acid
CurativeCurative: 200mg FeSo4 3 times daily till: 200mg FeSo4 3 times daily till
Hb level becomes normal, thenHb level becomes normal, then
maintenance dose of 1 tab formaintenance dose of 1 tab for
100 days100 days
14. WHO recommended for iron supplementation
for any pregnant women :
All pregnant women should be given the
standard dose of iron or folate (tab of 30 mg
iron + 400 mg folic acid/day ) every day for
women with normal iron stores for 6 months
during pregnancy and continuing post partum
Avoid iron supplement during 1st
trimester and
give after nausea subsided.
15. Curative and management of anemia
Oral supplementation ferrous sulphate
Parenteral iron therapy.
1. When diagnosed late in pregnancy
2. Malabsorption
3. Gastric intolerance to oral iron
Blood transfusion
During blood transfusion :monitor uterine activity ,
FM , FHR
Plus routine observation
16. Natal and post natal care:
Assess the Hb prior to delivery
Give blood if Hb% decreased 10.5 mg/dl.
Prevent infection.
Insure adequate hydration.
Practice an active management of 3rd
stage.
of labour advise to seek contraception.
17. Sickle cell anemia
An inherited disorder caused by abnormal Hb% in
the blood (abnormal shape) lead to hypoxia ,
dehydration ,infection , fatigue crisis
Effect on the pregnancy :
Effect on the organs and placenta blockage of
vessels & infarcts in organs , blockage to the
placenta , circulation occurs lead to fetal death &
increase risk for abortion.
18.
19. Management
Blood transfusion to maintain hematocrit
increased 30%.
Management during labour
O2 supplement
I.V fluid
fetal monitoring
antibiotic if C/S birth
20. Effects on pregnancyEffects on pregnancy
Increase incidence of abortion, prematurity,Increase incidence of abortion, prematurity,
IUGR and Fetal loss.IUGR and Fetal loss.
Perinatal mortality is high.Perinatal mortality is high.
Incidence of pre-eclampsia, postpartumIncidence of pre-eclampsia, postpartum
hemorrhage and infection is increased.hemorrhage and infection is increased.
21. Thalasemia
Abnormal Hb haemolysis
Risk for infection.
Avoid iron accumulation by using
chelating factor.
Monitor fetal and maternal condition.
22. Folic acid deficiency anemia
(megaloplastic anemia(
Folic acid is needed for increased cell growth of both mother
and fetus (necessary in all body cells synthesis DNA)
Occurs as a result of inadequate intake , poor absorption ,
increased use & poor cooking habits.
Decreased folic associated with decreased B12 vit
Decreased folic acid associated with decreased iron mainly
Occurs in the last trimester due to increased demand &
decreased intake
23. Pernicious anemia (vit B12 deficiency(
In adequate intake vegetarian
Common in elderly person & females