Lecture anemia and pregnancy

2021-03-22 12:00 AM

In particular, a lack of Vitamin B12 also causes giant red blood cell anaemia. So the manifestation of anaemia in pregnancy is manifested iron deficiency, more rarely, folate deficiency.

Preamble

Anemia in pregnancy accounts for 10-15% of severe anemia, accounting for 1/5 of the total anemia in pregnancy. Anemia will increase maternal and fetal mortality (possible fetal failure, premature delivery ...)

Hematological changes during pregnancy 

In the body of pregnant women, there is always an increase in plasma volume manifested in the first trimester of pregnancy, usually increasing between 30-50% at the end of pregnancy). Often there is an increase in the volume of the plasma rather than the hemoglobin (especially erythrocytes) leading to a decrease in the hematocrit, so it is not possible to rely on the hematocrit factor to diagnose anemia.

Iron metabolism also changes during pregnancy and its requirements often increase:

Due to increased erythropoiesis.

Due to the need of the fetus, it varies from 200-300 mg and doubles in the case of twins.

Not having periods during pregnancy also limits iron consumption. In addition, iron absorption during pregnancy increases by 30 - 90%, and the need to mobilize iron reserves of the mother allows maintaining the balance of supply and demand in the late stages of pregnancy if there is no previous iron deficiency. during pregnancy or unusual iron consumption due to multiple pregnancies or bleeding during pregnancy. Blood loss during pregnancy or lactation in the postpartum period also increases the need for iron and it is pregnancies too close together that will not allow the regeneration of the iron stores of pregnant women.

Another change in pregnancy is the metabolism of folic acid. Folic acid is an essential cofactor for DNA synthesis. If this synthesis is abnormal, there will be an effect on erythrocytes, it will produce abnormally large red blood cells but contain a normal amount of hemoglobin. Folic acid is essential for the mother and fetus. The requirement for folic acid is usually doubled during pregnancy. Adequate dietary intake will increase the requirement except in the case of disturbances in folic acid absorption and folic acid deficiency is often associated with iron deficiency. These are also the two main causes of anemia during pregnancy.

In particular, a lack of Vitamin B12 also causes giant red blood cell anemia. So the manifestation of anemia in pregnancy is manifested iron deficiency, more rarely, folate deficiency.

Define 

Pregnancy anemia is defined as a hemoglobin (Hb) ratio <10g / 100ml and is called severe anemia if the Hb is <8g / 100ml of blood.

Causes and risk factors

Layed many times.

Prolonged breastfeeding.

Multiple pregnancies.

Bleeding persists before pregnancy (menorrhagia ...).

Poor nutritional diet.

From an epidemiological perspective, North African women have all the advantages mentioned above.

Another advantageous factor is urinary tract infections (especially chronic urinary tract infections that also often cause anemia).

Symptoms

Clinical

Pale skin and mucous membranes.

Asthenia.

Tachycardia, shortness of breath, tinnitus, dizziness.

Maybe glossitis (last 3 months of pregnancy)

Mild jaundice: may be caused by a lack of Folate

Subclinical

Tests for blood count: red blood cells decreased.

Hemoglobin (Hb) decreased <10g / 100ml of blood.

Bone marrow examination: small red blood cells, large red blood cells, and normal red blood cells, depending on the type of anemia.

Serum iron tests, folic acid, and folic acid all decreased.

Prognosis

Anemia during pregnancy can lead to:

Risk of preterm birth, fetal malnutrition.

Increase the volume of vegetable cakes.

If additional bleeding during pregnancy, labor, after delivery ... then the situation of pregnant women is worse than normal women.

The lack of oxygen makes the mother tired, and her heart rate faster.

In the postpartum period, anemia often increases the risk of postpartum infection (thrombophlebitis).

Treatment

If the Hb ratio> 8g / 100ml for women to use (iron) Fe at a dose of 200mg per day is enough, there is no need to pass blood to pregnant women. You can use Tardyferon 80 mg, Tardyferon B9, Ferrous sulfate: use continuously during pregnancy and in the first 6 months postpartum. If the patient is intolerant to ingestion of iron drugs (in the first 3 months of pregnancy if vomiting is severe), parenteral administration: Jectofer 100 mg: 2 ampoules of 2 ampoules per day are administered intramuscularly.

More blood can be transferred to the pregnant woman if the Hb ratio is <8g / 100ml. Blood transfusion should be done before 36 weeks or in preterm labor treatment, combined with iron treatment for at least one month to prevent loss of blood decompensation at birth and after vegetable registration.

Lower-level prophylaxis in pregnancy management by administering iron to pregnant women throughout pregnancy (especially women at risk of anemia). Give iron prophylaxis Ferrous sulfate 100mg per day. In addition to iron, it is necessary to use a combination of folic acid, folate (for mothers with a history of their child with a neural tube malformation (spina bifida) or taking folic acid anti-folic drugs, even three-month prophylaxis. before conception: give Speciafuldine 5 mg daily or Lederfolin 15 days by mouth.

Prevention 

The risk of anemia in pregnancy should be detected by testing for:

CBC: in the fourth month of pregnancy and depending on outcome for management.

Hemoglobin test for treatment if Hb <10g / 100ml.

If the examination reveals lymph nodes, leukopenia, neutropenia, acute leukemia, lymyocytoma, hereditary thrombocytopenic hemorrhage ... need to invite a blood transfusion specialist to join the association. diagnosis and treatment.

For countries with slow progress or developing countries like our country, today still appear anemia in pregnancy, so the management of pregnancy needs to do well in terms of quality, from which there are plans to prevent the risk to mother and child is caused by anemia.