1. anaemia in pregnancy

anaemia in pregnancy

1. SUBMITTED BY:
PRAMODINI BUTLE
2
ND
YEAR M. SC.

2. DEFINITION
•ANEMIA IN PREGNANCY IS PRESENT WHEN THE
HAEMOGLOBIN LEVEL CONCENTRATION IN THE
PERIPHERAL BLOOD IS 11GM/100ML OR LESS.

3. CLASSIFICATION
1.PHYSIOLOGICAL ANAEMIAS IN PREGNANCY
2.PATHOLOGICAL
3.DEFICIENCY ANAEMIA
4.HAEMORRHAGIC
5.HAEMOLYTIC
6.BONE MARROW INSUFFICIENCY
7.HAEMOGLOBINOPATHIES.

4. ANAEMIA

5. APLASTIC ANAEMIA

6. MACROCYTIC

7. SICKLE CELL ANAEMIA

8. MEGALOBLASTIC ANAEMIA

9. TYPES OF ANAEMIA

10. CRITERIA OF PHYSIOLOGICAL
ANAEMIA
•THE LOWER LIMIT OF PHYSIOLOGICAL ANAEMIA
DURING THE HALF OF PREGNANCY SHOULD
FULFIL THE FOLLOWING HAEMATOLOGICAL
VALUES Hb 10GM%,RBC 3.2MILLION/MM3,PCV
30%,PERIPHERAL SMEAR SHOWING NORMAL
MORPHOLOGY OF THE RBC WITH CENTRAL
PALLOR.

12. CAUSES

13. FAULTY DIETETIC HABIT

14. FAULTY ABSORBTION OF IRON

15. REPEATED PREGNANCY

16. MORE SWEAT

17. EXCESSIVE BLOOD LOSS

18. HOOKWORM INFESTATION

20. DURING PREGNANCY
•INCREASED DEMANDS OF IRON
•DIMINISHED INTAKE OF IRON
•DISTURBED METABOLISM
•PRE-PREGNANT HEALTH STATUS
•EXCESS DEMAND
1.MULTIPLE PREGNANCY
2.WOMEN WITH RAPIDLY RECURRING
PREGNANCY

21. IRON DEFICIENCY ANAEMIA
SYMPTOMS
•LASSITUDE AND A FEELING OF EXHAUSTION OR
WEAKNESS
•ANOREXIA AND INDIGESTION
•PALPITATION
•DYSPNEA
•GIDDINESS
•SWELLING OF THE LEGS

22. SYMPTOMS

23. IRON DEFICIENCY ANAEMIA ON
EXAMINATION
•PALLOR OF VARYING DEGREES
•OEDEMA OF THE LEG
•A SOFT SYSTOLIC MURMUR
•CREPITATION MAY BE HEARD

24. IRON DEFICIENCY ANAEMIA
INVESTIGATION
•HAEMOGLOBIN LEVEL
•TOTAL RED BLOOD CELL
•PACKED CELL VOLUME
•MILD ANAEMIA-BETWEEN 8 TO 10 GM %
•MODERATE ANAEMIA-BETWEEN 6.5 TO LESS
THAN 8 GM %
•SEVERE-LESS THAN 6.5GM%

25. TO ASCERTAIN THE TYPE OF ANAEMIA
•PERIPHERAL BLOOD SMEAR
•EXAMINATION OF A WELL MADE PERIPHERAL
BLOOD SMEAR STAINED WITH LEISHMAN STAIN TO
THE MORPHOLOGY OF THE
CELLS.ANISOCYTOSIS,POIKILOCYTOSIS,SUGGEST
MICROCYTIC HYPOCHROMIC ANAEMIA.

26. HAEMATOLOGICAL INDICES
•HAEMOGLOBIN-LESS THAN 10GM%
•RBC-LESS THAN 4 MILLION /MM3
•PCV-LESS THAN 30%
•MCHC-LESS THAN 30%
•MCV-LESS THAN 75MU M3
•MCH-LSS THAN 25pg

27. OTHER BLOOD VALUES
•SERUM IRON-30MU/G/100ML
•TOTAL IRON BINDING CAPACITY IS ELEVATED
400MU/G/100ML
•PERCENTAGE SATURATION IS 10% OR LESS.
•SERUM FERRITIN BELOW 10MU/L

28. CAUSE OF ANAEMIA
•EXAMINATION OF THE STOOL
•THE URINE IS EXAMINED
•PLACE OF BONE MARROW STUDY
•INFECTION

29. COMPLICATION OF ANAEMIA
•DURING PREGNANCY
•PRE ECLAMPSIA
•INTERCURRENT INFECTION
•HEART FAILURE
•PRETERM LABOUR

30. DURING LABOUR
•UTERINE INERTIA
•PPH
•CARDIAC FAILURE
•SHOCK

31. PUERPERIUM
•PUERPERAL SEPSIS
•SUBINVOLUTION
•FAILING LACTATION
•PUERPERAL VENOUS THROMBOSIS
•PULMONARY EMBOLISM

32. EFFECTS ON THE BABY
•THERE IS INCREASED INCIDENCE OF LOW BIRTH
WEIGHT BABIES WITH ITS INCIDENTAL HAZARDS.
•INTRAUTERINE DEATH

33. PROGNOSIS
•MATERNAL
•FETAL

34. TREATMENT
•PROPHYLACTIC
•SUPPLEMENTAL IRON THERAPY
•DIETARY PRESCRIPTION
•ADEQUATE TREATMENT
•EARLY DETECTION

38. CEREALS AND PULSES

39. GREEN LEAFY VEGETABLES

40. ALL YELLOW AND RED
VEGETABLES

41. ALL CITRIC FRUITS

42. LIVER

43. GENERAL TREATMENT

44. CURATIVE
•HOSPITALIZATION
•GENERAL TREATMENT
1.DIET
2.TO IMPROVE THE APPETITE AND FACILITATE
DIGESTION
3.TO ERADICATE SEPTIC.

46. SPECIFIC THERAPY
•ORAL THERAPY
1.FERSOLATE TABLET CONTAINS 200MG FERROUS
SULPHATE WHICH CONTAINS 60 MG OF
ELEMENTAL IRON TRACE OF COPPER AND
MANGANESE.
2.THRICE DAILY ONE TABLET.

47. DRAWBACK OF FERROUS
SULPHATE
•INTOLERANCE.
•UNPREDICTABLE ABSORPTION RATE.
•THERAPEUTIC DOSE.

48. RESPONSE OF THERAPY IS
EVIDENCE BY
•SENSE OF WELL BEING
•INCREASED APPETITE
•IMPROVED OUTLOOK OF THE PATIENT
•HAEMATOLOGICAL RISE

49. RATE OF IMPROVEMENT
•THREE WEEKS OF THERAPY
•0.7GM/100ML PER WEEK

50. CONTRAINDICATION OF ORAL
THERAPY
•INTOLERENCE TO ORAL IRON
•SEVERE ANAEMIA

51. PARENTERAL THERAPY
•INTRAVENOUS ROUTE
•INTRAMUSCULAR ROUTE

52. INDICATIONS
•CONTRAINDICATION FOR ORAL THERAPY
•PATIENT IS NOT CO-OPERATIVE TO ORAL IRON

53. TOTAL DOSE INFUSION
•THE COMPOUND USED IS IRON DEXTRAN
COMPOUND,1ML OF WHICH CONTAINS 50MG
ELEMENT IRON AND ONE AMPOULE CONTAINS 2ML.

54. INTRAMUSCULAR THERAPY
•IRON DEXTRAN
•IRON SORBITOL CITRIC ACID

55. INDICATION FOR BLOOD
TRANSFUSION
•TO CORRECT ANAEMIA DUE TO BLOOD LOSS.
•TO IMPROVE OXYGEN CARRYING CAPACITY OF
BLOOD
•REFRACTORY ANAEMIA

56. MANAGEMENT DURING
LABOUR
•FIRST STAGE
•THE PATIENT SHOULD BE ON BED
•PAIN RELIEF
•ARRANGEMENT FOR OXYGEN INHALATION
•STRICT ASEPSIS

57. SECOND STAGE
•ASEPSIS AND INTRAVENOUS METHERGIN 0.2MG
SHOULD BE GIVEN FOLLOWING THE DELIVERY OF
ANTERIOR SHOULDER.

58. THIRD STAGE
•FRESH PACKED CELL
TRANSFUSION

59. PUERPERIUM
•BED REST
•ANY SIGNS OF INFECTION SHOULD BE NOTED
•PREDELIVERY ANTI ANAEMIC THERAPY AND POST
DELIVERY 3 MONTHS

60. NURSING MANAGEMENT

61. NURSING DIAGNOSIS
•ALTERED NUTRITION LESS THAN BODY
REQUIREMENTS RELATED TO INADEQUATE IRON
INTAKE DURING PREGNANCY,IRON
MALBASORPTION, POOR DIETARY HABITS

62. PLANNED INTERVENTION
•ASSESS UNDERSTANDING OF NUTRITIONAL IRON
REQUIREMENT
•ABILITY TO SELECT WELL BALANCED DIET
•ASSESS THE SYMPTOMS OF IRON DEFICIENCY AND
FOR BLOOD LOSS DURING DELIVERY
•MONITOR SERUM
FERRITIN,HEMOGLOBIN,HEMATOCRIT
•CONSULT DIETITIAN
•ADMINISTER PRESCRIBED IRON MEDICATION
BETWEEN MEALS
•DESCRIBE SIDE EFFECTS OF IRON MEDICATION
•ANTICIPATE BLOOD REPLACEMENT IF NO
RESPONSE TO DIET.

63. ACTIVITY INTOLERENCE RELATED TO
DECREASED OXYGEN SUPPLY TO CELLS
•ASSESS PATIENT ABILITY TO
PERFORMANCE,RESPIRATORY AND CARDIAC
STATUS BEFORE AND AFTER ACTIVITY
•PROVIDE ASSISTANCE FOR ACTIVITY PATIENT
CAN’T PERFORM
•INSTRUCT PATIENT TO INCREASE ACTIVITY LEVELS
AS TOLERATED
•REASSURE PATIENT THAT ANAEMIA ASSOCIATED
FATIGUE IS TEMPORARY.
•ENCOURAGE PATIENT TO SEEK ASSISTANCE WITH
INFANT AND HOUSEHOLD ACTIVITIES AFTER
DISCHARGE

64. HIGH RISK FOR INFECTION RELATED TO
DECREASED RESISTANCE
•MONITOR SERUM HEMOGLOBIN
•SEND URINE FOR CULTURE ABG
SENSITIVITY
•ADMINITER ANTIBIOTIC AS PRESCRIBED

65. DISCHARGE PLANNING
•CONTINUE TO MONITOR HEMOGLOBIN AND
HEMATOCRIT
•STRESS THE IMPORATANCE OF FOOD RICH IN IRON
•STRESS IMPORATANCE OF CONTINUINING TO TAKE
IRON SUPPLEMENT AS ORDERED