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Anaemia in Pregnancy

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Most common anaemia during pregnancy is iron deficiency anaemia. The woman who has got enough iron reserve and is on balanced diet is unlikely to develop anaemia during pregnancy. But if the iron reserve is less or absent, the factors which could cause anemia are:

Decreased intake of iron like seen in women belonging to low socioeconomic group, faulty eating habits, loss of appetite & vomiting.
Disturbed formation of blood during pregnancy, which is normal.
Pre-pregnant health status of the woman (if she had anemia before pregnancy).
Abnormal demands like in twin pregnancy or recurring pregnancies.
Teenage pregnancies.
Commonly seen anaemia is Iron deficiency anaemia.

Features:
If anaemia is not severe there may not be any symptoms. But if it is severe, then common features are:
Lethargy and feeling of exhaustion all the time.
Loss of weight, indigestion, palpitation, breathing difficulty, giddiness & swelling of legs.
Investigation:
Investigations help to confirm the diagnosis. Any person who has haemoglobin level less than 10 gm % needs to be thoroughly investigated.
Along with blood tests, stool & urine also has to be tested.

Complications:
Complications occuring due to severe anaemia are:

Repeated infections occur due to decreased resistance of the body to infections.
Heart failure may occur.
Preterm labour (labour starting before time).
During labour severe anaemia causes:
Excessive bleeding after delivery called post partum haemorrhage.
Heart failure.
Shock
During Puerparium (time after delivery).
Sepsis may occur.
Failure of uterus to come back to normal size.
Failing of lactation may occur.
Effect on baby
Prematurity is commonly seen.
Intra uterine death of the baby may occur.

Management:

It would be divided into (2)-
Prophylactic (prevention)
To avoid frequent child births.
Supplementary iron tablets to be taken..
Food rich in iron to be eaten..
Early detection of this deficiency.
Adequate treatment is to be taken..
Curative
Anaemia is not a disease but a sign of underlying disorders. Treatment must be preceded by accurate diagnosis of the cause of anaemia & type of anaemia.


General Treatment:
Diet
Balanced diet rich in protiens, iron & Vitamins, food like liver, meat, egg, green vegetables, green peas, figs, beans, whole wheat & green bananas etc.is to be taken.
Effective treatment is to cure the diseases which is causing anaemia.

Specific Therapy:
Main aim is to increase haemoglobin level and keep it that way till patient goes into labour.

Choice of therapy depends upon-
Severity of anaemia.
Duration of pregnancy and
Associated complicating factor.

Iron Therapy :
Oral
Iron has to be taken in the form of medicine..
Parenteral
Injections of iron is given..Haemoglobin takes 4-10 weeks to come to normal or near normal depending upon severity of the anaemia.

Blood transfusion is given in severe anaemia and those occuring in later months of pregnancy (beyond 36 weeks).