Anemia in pregnancy

Question 1

What is the definition of anemia in pregnancy?

Answer 1

• 1st trimester: Hb <11 g/dl
• 2nd trimester: Hb <10.5 g/dl
• 3rd trimester: Hb <11 g/dl
• puerperium: <10 g/dl

Question 2

What is the presentation of iron deficiency anemia in pregnancy?

Answer 2

• dizziness
• headache
• shortness of breath
• glossy tongue
• pale complexion
• spoon-shaped nails
• chest pain
• palpitations
• irritability or poor concentration
• cracks in the corner of your mouth

Question 3

What are the causes of anemia in pregnancy?

Answer 3

Deficiency
- iron
- folate
- B12

Hemoglobinopathies
- sickle cell
- thalassemia

Infections
- HIV
- TB
- Malaria

Question 4

What are the risk factors for anemia in pregnancy?

Answer 4

• family history
• poor nutrition
• malabsorption
• multiparity
• multiple gestations
• chronic bleeding

Question 5

What investigations are done for diagnosis of anemia?

Answer 5

• Hb level, hematocrit, MCV, MCHC
• serum iron, folate & B12
• Peripheral film: look at shapes of RBC
• Hb electrophoresis: look at type of Hb

Question 6

What are the characteristics of iron deficiency anemia?

Answer 6

• decreased hemoglobin production
• microcytic hypochromic
• MCV < 80
• serum ferritin < 10 - 15 mg/L

Question 7

How is iron deficiency anemia managed in pregnancy?

Answer 7

• oral iron, ferrous sulphate, fumarate, gluconate -> 200mg elemental iron

if unstable or Hb < 7
- IV iron
- blood transfusion

Question 8

What are the complications of anemia in pregnancy?

Answer 8

• low birth weight
• IUGR
• preterm delivery
• postpartum hemorrhage (atonic)
• ## postpartum DVT & infection

Question 9

What are the causes of megaloblastic anemia?

Answer 9

• folic acid deficiency
• B12 deficiency

impaired DNA synthesis -> bone marrow & blood abnormalities

Question 10

What are the causes of acute blood loss?

Answer 10

• ectopic pregnancy
• miscarriage
• molar pregnancy
• secondary to postpartum hemorrhage

treat by blood transfusion

Question 11

What are the causes of sickle cell crises?

Answer 11

• infection
• hemorrhage
• hypoxia
• stress

Question 12

How is a sickle cell crises managed in pregnancy?

Answer 12

1- hydration, oxygen, & analgesia
2- screen for infection
3- antibiotics
4- leucocyte depleted & phenotype specific blood transfusion
5- exchange transfusion
6- prophylaxis against thrombosis (heparin)
7- fetal monitoring

Question 13

What is the effect of sickle cell anemia on pregnancy?

Answer 13

• miscarriage/stillbirth
• thromboembolic events
• pre-eclampsia/eclampsia
• fetal growth restriction
• preterm labour
• maternal mortality

Question 14

How are complications of sickle cell anemia prevented in pregnancy?

Answer 14

• low dose aspirin 75mg tabs
• folate 4mg throughout pregnancy