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BLOOD VOLUME
Increases by 30%
50% rise in plasma volume
+20% rise in erythrocyte volume
Increased in multiple
pregnancy, hydatidiform mole
Decreased in abortion, stillbirth
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PURPOSE
Fill up enlarged uterus and its
hypertrophied vessels
Meet fetal demands Protect mother against blood loss
Protect fetus against impairedvenous return ( like in supine posture)
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PLASMA VOLUME
Starts at 6 weeks
Most rapid in second trimester
Plateaus around 32 weeks
Total increase 50% (ml)
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ERYTHROCYTE VOLUME
Starts at 10 weeks
Peaks in second trimester
Continues till term
Total increase 20% (250 ml)
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0
10
20
30
40
50
60
plasma RBC blood
Physiological anemia of pregnancy
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results
Physiological anemia ( 11-12 mg/dl) as
against a normal 12-16mg/dl
Fall in erythrocyte count, hematocrit But total RBC volume increases
MCH, MCV , MCHC normal
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OTHERS
leucocyte count increase( 20000-25000 ) at
labour and puerperium
Platelet count increases
Total serum protein and albumin decrease
Immunoglobulins & fibrinogen increase
Hypercoagulability as all factors except2,11,13
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ANAEMIA IN PREGNANCY
Most common complication
Incidence in india- 40-90%
Accounts for 10-15% of maternalmortality
Occurs when Hb conc goes below11mg/dl (WHO) and 10mg/dl (FOGSI)
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causes
Directly related to pregnancy
Iron deficiency
Folate /B12 deficiency anemia due to acute blood loss
Anemia of chronic disease
Pregnancy induced hemolytic anemia
HELLP syndrome
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anemia not directly related
All anemias are worsened in pregnancy
Hemolytic anemias
Hemoglobinopathies
Aplastic anemia
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IRON DEFICIENCY ANEMIA
Most common
Commonly due to malnutrition
Others: parasite infestation, c/c bloodloss, malabsorption
Microcytic hypochromic
TOTAL IRON NEEDED: 1000 mg (fetus300, mother Hb expansion 500, shed 200)
in addition to 150-200mg each for delivery
loss and lactation
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An assesment..
normal requirement in non pregnant
women:1-2 mg/day
on average 5% of dietary iron absorbed So daily intake needed:20-22 mg/day
(marginal)
Pregnancy requirement: 4-6mg/dayso required intake 40-60 mg/day
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Scenario in india
Low socioeconomic status Poor intake
Vegetarian source(1% absorbed)
Parasitic infestations
Multiple pregnancies
Other c/c diseases
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MEGALOBLASTIC ANEMIA
Low plasma conc. and increased demand
for folic acid & vitamin B12
macrocytic Folate Requirement in pregnancy: 400
microgram/day
vitamin B12 -0.6-0.7 microgram/ day
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others
PIHA- rare, unexplained
HELLP syndrome-
microangiopahic, follows severe
preecclampsia
Anemia of a/c blood loss- normocytic
normochromic
Anemia of c/c diseases-c/c renalfailiure, c/c infection, inflammatory
diseases, neoplasms (normocytic
normochromic )
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