ANAEMIA IN PREGNANCY

Anaemia is the most frequent and major complication of pregnancy. It may be defined as haemoglobin level below the normal (11.5 g/dL for pregnant women).

Causes

  • Nutritional causes; iron deficiency, folic acid deficiency
  • Infections and infestations; hookworm infestation, malaria, UTI, HIV/AIDS
  • Haemorrhagic causes: bleeding in pregnancy, trauma
  • Any other causes

Clinical features

Mother may give history of

  • Gradual onset of exhaustion or weakness
  • Swelling of the legs
  • Dyspnoea, dizziness, and palpitations

On examination

  • Pallor of the conjunctiva, tongue, palm, vagina, etc., of varying degree, depending on the severity of anaemia
  • Glossitis and stomatitis
  • Oedema of the legs
  • In very severe cases: evidence of heart failure such as engorged neck veins, dyspnoea, hepatomegally, ascites,
    gallop rhythm, and oedema

Complications

  • Untreated anaemia may increase the risk of premature labour, poor intrauterine foetal growth, weak uterine
    contractions, foetal hypoxia, postpartum haemorrhage, poor lactation, post-partum sepsis

Investigations

  • Blood
    • Hb (<11.5 g/dL is considered abnormal)
    • Peripheral smear to determine the type of anaemia and presence of malaria parasites
    • Sickling test to exclude sickle-cell disease
  • Stool: ova and cysts of hookworm infestation

MANAGEMENT

Prophylaxis

  • All pregnant women should receive ferrous and folic acid daily from 12 weeks. Continue
    supplementation until 3 months after delivery.

If severe anaemia(Hb ≤7 g/dL) or patient has heart failure

  • Refer patient to a well-equipped facility for further management

If Hb >7 g/dL

  • Give combination of ferrous and folic acid 3 times daily
  • Review the mother every 2 weeks (Hb should rise by 0.7-1 g/dL per week)
  • Emphasise a realistic balanced diet rich in proteins, iron, and vitamins, e.g., red meat, liver,
    dark green vegetables
  • Treat malaria presumptively with SP and follow up
  • De-worm the patient with mebendazole 500 mg single dose in 2nd and 3rd trimesters
  • Treat any other cause as found from investigations
  • Advise child spacing with an interval of at least 2 years

If not improving, refer to hospital
If mother still anaemic at 36 weeks of gestation, or at time of delivery

  • Refer to a well-equipped facility for further management (blood transfusion)

If patient has sickle-cell disease

  • Refer to higher level for ANC and delivery

Prevention/Health Education

  • Explain the possible causes of anaemia
  • Advise on nutrition and diet: mother should increase consumption of foods rich in iron and vitamins
  • Instruct patient to use medication as prescribed, and the dangers of not complying
  • Advise on side effects of iron medicines (e.g. darkened stools)
  • Instruct patient to come every 2 weeks for follow-up