ANAEMIA IN PREGNANCY
Hb < 11 g/d1 in 1st trimester, < 10.5 in 2nd 3rd and <10 immediately
WHO- lower limit should be 2 SD below the normal population
Mild <11 – 9
Moderate 8.9- 7
Severe < 7
TYPES AND CAUSES
Commonest type is Iron deficiency anaemia due to:
Haemodilution – Physiological Anaemia due to disproportionate
increase in plasma volume (30%-40%) Vs. Red cell volume
o May not be apparent in pre-eclampsia
Iron utilisation increases as is required for fetal growth and
development as well as maternal erythropoiesis.
o Demand worsens as pregnancy advances. (2nd and 3rd term)
o requirement per day in 1st trimester is 3-4mg/day and 6-7
mg/day in 2nd
o Demand more in multiple pregnancies
Increased maternal and Foetal morbidity and mortality.
■ Cardiac failure
■ Sepsis (infections)
■ Unable to withstand even minor acute blood loss.
■ Increased risk of maternal mortality ( Hb< 7)
o Foetal :
■ Preterm labour
■ Low birth weight
o Dyspnoea (breathlessness)
o Weakness, fatigue.
o Others due to the cause:
■ Malaria – fever
■ Bleeding in pregnancy.
■ Pallor/ jaundice/ petechiae
■ Organomegaly 6
o Gestational age
• Haematinics – orally
• Hb will rise by 0.8 – 1.0g/dl per week.
• Ferrous formulations better than ferric
• Fumerate, sulphate and gluconate formulations
• Multivits have insufficient iron to correct anaemia
• Amount of elemental iron is what’s important
• 200mg Sulphate( 65mg), 300mg gluconate (35mg), 210mg
• Previously Recommended dose of elemental iron for
treatment is 100- 200mg , now 40mg- 80mg daily
• Should be taken in the morning and on an empty stomach
taken with water or a vitamin c source.
• Vit C enhances absorption and tannins in tea and coffee
• Avoid taking with other meds such as antiacids, multivits.
• Check Hb at 2-4 weeks after treatment
• Iron salts may cause gastric irritation – nausea, vomiting,
• Change formulation or reduce the dose in case of adverse
IV formulations ( Iron sucrose, iron dextran)
• By-passes gastric absorption
• Less side effects
• Faster absorption, quicker HB improvement
• Indicated in patients with malabsorption, intolerance,
poor compliance and need for rapid Hb boost.
• C.I : anaphylaxis, 1st trimester, active bacteremia and
decompensated liver disease.
• 1st and 2nd trimester. Orally
• 3rd trimester, term, labour Transfuse.
. Transfuse irrespective of gestation age but be careful it
may precipitate cardiac failure if the transfusion is rapid
i. Use packed cells
ii. Give fast acting diuretic eg frusemide before
iii. Slow transfusion.
Deal with the cause.
o Infestations – H/worm
o Stop bleeding.
o Diet-haem iron from meat is absorbed 2- to 3- times more readily than non
o Meat also contains organic compounds that promote absorption
o Iron and Folic acid supplements
o Antimalarials eg Fansidar.
o Pre-pregnancy correction of anaemia.
■ INTRAPARTUM MANAGEMENT
Actively prevent blood loss- AMTSL
Maximize pre-delivery HB
Women with Hb < 10 should be delivered at a center with an
Should not determine the mode of delivery.