Bleeding in Pregnancy

Question 1

Anemia Definition

Answer 1

low number of RBCs or a low number in the concentration of circulating blood

Question 2

Diagnosis of Anemia in Pregnancy

Answer 2

• 1st trimester Hgb <11 g/dl
• 2nd trimester Hgb <10.5 g/dl
• 3rd trimester Hgb <11 g/dl

Question 3

By law, when do we have to consult, refer, or transfer for anemia?

Answer 3

H/H

• Less than 31% or 10.3 gm/100 ml
• Less than 28% or 9.3 gm/100 ml.
• Sickle cell anemia.

Question 4

How can Anemia physiologically occur during pregnancy?

Answer 4

Hemodilution

Question 5

What is Hemodilution?

Answer 5

The increase in blood volume increases the plasma in the blood more than RBCs

Question 6

What are the etiologies of anemia?

Answer 6

• iron deficiency
• vitamin B12 deficiency
• folate acid deficiency

Question 7

S/S of nutritional anemia

Answer 7

• asymptomatic
• fatigue
• drowsy
• malaise
• dizziness
• weakness
• sore tongue
• pallor, pale mucous membranes
• SOB
• appetite loss
• cold hands and feet
• trouble concentrating

Question 8

What is the most common anemia?

Answer 8

Iron Deficiency

Question 9

What does iron rich anemia increase the risk of?

Answer 9

• low birth weight
• preterm delivery
• perinatal mortality
• postpartum depression

Question 10

Anemia diagnosis labs

Answer 10

• low serum ferritin and serum iron

- High TIBC or [RDW]

Question 11

What is hematocrit?

Answer 11

it is the percentage of RBC in your blood or percentage of RBC volume compared to your total blood volume

Question 12

Summary of normal hematological changes in pg

Answer 12

• plasma volume increase by 50 percent
• Red cell mass [total volume of red cells in circulation] increases by 20 percent
• physiological anemia of pg- as a result of the dilution effect of greater plasma increase in relation to increase in RBC
• WBC increase
• hypercoagulable state- changes to coagulation and fibrinolysis
• venous stasis
• isolated mild thrombocytopenia- platelet count tends to fall progressively to lower threshold of normal or below, near term, needs to be distinguished from pathological causes such as pre-e
• significant increase in requirement for iron, folate, and vit B12

Question 13

what is RBC job

Answer 13

they contain significant amounts of hemoglobin and their primary function is to transport oxygen in the blood.

Question 14

what does RBC maturation depend on

Answer 14

formed in the bone marrow, and their maturation is dependent on the presence of iron, vitamin B12, and folic acid, which are derived from the diet.

Question 15

how long does a RBC last

Answer 15

they survive on average for just 120 days in the circulation. as the cell ages it becomes increasingly fragile and most RBC break down in the narrow vasculature of the spleen but some in the liver

Question 16

why does total RBC volume increase in pg

Answer 16

reflects the increased fetal and maternal demand for oxygen.

Question 17

why iron is important in in pg

Answer 17

iron is needed for extra RBC production, for certain enzymes required for the function of tissue, for the fetus and placenta, and to replace the increased normal daily loss. fetal requirements are greatest in last 4 weeks of pg, will be met preferentially at the cost to the mother.

Question 18

the demand for iron in pg

Answer 18

met partly by the absence of menses and increased absorption of dietary iron by the intestinal mucosa, but it does also rely on maternal iron stores. absorption of iron is less than 10 percent of that contained in the diet and the average diet cannot meet this demand. demand outstrips supply for most women especially poor resources or western diet.

Question 19

why is there increased risk of PPH with low hemoglobin

Answer 19

uterine contraction is impaired due to the reduced availability of oxygen to the cells

Question 20

what are some maternal complications of anemia in pg

Answer 20

• preterm delivery
• placental abruption
• increased pp blood loss [secondary to impaired uterine muscle function]
• lower tolerance to blood loss
• increased susceptibility to infection
• decreased ability to perform daily functions
• disturbances of pp cognition and emotion

Question 21

what are some fetal/ infant complications of anemia in pg

Answer 21

• low birth weight
• iron deficiency in first 3 months of life
• impaired psychomotor and or/ mental development

Question 22

If a client does not want to continue taking iron supplements but needs to what advise to give

Answer 22

let midwife know, so a different formulation can be recommended. taking a lower dose, taking it on alternate days, or even taking it just twice weekly is better than discontinuing the supplement.

Question 23

how often should labs be done for anemia after treatment has started

Answer 23

after 2-3 weeks to check if its working

Question 24

if Hb is within normal limits what advice should be given

Answer 24

continue taking iron tablets for 3 months and until at least 6 weeks pp to enable her iron stores to be replenished