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