ANEMIA IN PREGNANCY_ gynecology & obstetrics

Anemia in pregnancy _ Gynecology and Obstetrics lecture

1. Anemia in Pregnancy USHNA RAUF 50 TAYYABA TARIQ 87

2. THE WHO DEFINES ANEMIA IN PREGNANCY AS HB CONCENTRATION OF LESS THAN 11.0 g/ dL DEFINITION

3. DEGREE MILD  9-11 g/ dL MODERATE 7-9 g/ dL SEVERE less than 7g/ dL VERY SEVERE less than 4g/ dL

4. I ncidence PAKISTAN:During a study period, out of 1250 pregnant women,700 were anemic giving the frequency of anemia as 56%. WORLD: 37% of pregnant women are anemic.

5. Classification based on size of RBC Microcytic anemia Iron def Thalassemia ( beta,alpha ) Sickle cell anemia Macrocytic anemia Pernicious anemia Folate andB12 deficiency Normocytic anemia Acute blood loss Aplastic anemia

6. 01 02 03 04 05 06 Deficient intake Inadequate diet Low socioeconomic status Increased Demand M ultiple pregnancy T eenage pregnancy Chronic illness P repregnancy anemia Excessive loss Menorrhagia Hookworm infestation Malaria Blood loss at delivery CAUSES

7. Symptoms of anemia in pregnancy D ifficulty breathing,especially with physical exertion. P alpitations also maybe present Breathlessness U nusual cravings for ice, dirt,raw rice. PICA C old hand and feet Feeling unusually tired or weak , even after getting enough rest Dizziness and Fatigue Visible On palm and conjunctiva Pale skin Irritable

8. . Conjunctival pallor Glossitis stomatitis Pallor Pale nails, Koilonychia,Platynychia Soft systolic murmurs due to hyperdynamic state Fine crepitations Hepato-splenomegaly Oedema Hypoproteinemia SIGNS OF ANEMIA

9. Complications

10. About anemia Despite being red, Mars is a cold place Fever It’s the second planet from the Sun Sight It’s the biggest planet of them all Swelling Pale Skin It’s a gas giant and has several rings

11. CBC I ron indices Peripheral Blood Smear Hb below 11g/Dl MCV below 80fL MCHC below 28g\dl Serum iron,S erum ferritin,TIBC M icrocytic,hypochromic T arget cell in thalassemia A nisocytosis,poikilocytosis INVESTIGATIONS Reticulocyte count ELECTROPHORESIS

12. MANAGEMENT based on degree of anemia and type of anemia IRON deficiency anemia P arenteral blood Mild –oral tablets(ferrous sulphate) Moderate –oral or parenteral Severe-parenteral or blood transfusion 1 unit of blood is 5 g\dL Hb increases by 0.8-1l Thalassemia Hb levels again Never administer ferrous sulphate or ferric carboxymaltose to thalassemia pt. leads to iron overload O ral- 1month P arenteral-14 days

13. PROPHYLACTIC MANAGEMENT Screening( 1 st visit , 20 , 28 , 30 36 wks ) Iron 200 mg e folic acid

14. MCQ A 31 year old woman G4P1A2 presents with breathlessness and palpitations.her HB was less than 7 g/d L. treatment for her is A. Packed cell transfusion B. Oral ferrous sulphate C. Wait for delivery D. Counselling and conservative treatment. IOC IN SAME PT?? Serum ferritin levels

15. THANKS