Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
ANEMIA IN PREGNANCY

 DR SHABNAM NAZ
      ASSISTANT PROFESSOR
             OBGYN
     CMC,SMBBMU LARKANA
definition

A pathological condition in which the oxygen
  carrying capacity of red blood cells is insufficient
  to meet ...
PREVALANCE-
40% of world ‘s population
(35%non-preg 51%pregnant)
56% in Pakistan
MORTALITY
40-60% IN Pakistan
18% in indus...
PHYSIOLOGICAL CHANGES IN BLOOD
DURING PREGNANCY
 Plasma volume increased      50%
 Red cell mass increased      25%
 Fa...
Severity of anemia
Severity      Percentage       hemoglobin
                              values

MILD          13       ...
Degrees of anemia
CLASSIFICATION of ANEMIA
 Physiologic
 Pathologic:
  a. Deficiency: Iron, Folic A., Vitamin B12
  b. Hemorrhagic: APH, H...
IRON DEFICIENCY
    ANEMIA
IRON ABSORBTION
 Dietary iron (heme and non heme)
- heme-animal blood flesh viseras
-Non heme-cerels, seeds, vegetables, ...
 Ferrous iron
 Gastric acidity
 Alcohol
 Low iron stores
 Increase erethropiioetic activity(hight altitue,bleeding)
 ...
IRON LOSS
PHYSIOLOGIC FACTORS
 Desquamation of cells( intestine, skin)
 Menstruation
 Delivery
 Lactation
PATHOLOGIC F...
Iron requirement in pregnancy
 Adult woman absorption-2mg/day
 Total iron requirement during pregnancy-900mg
DEMANDS
 E...
PREVENTION OF IRON DEFICIENCY
1.Iron supplementation during pregnancy
According to WHO 60 mg elemental iron and 250mg foli...
Prevention continue…..
4.Social services
Improvement in sanitation
Personal hygiene
Better education of female regarding d...
Concept of Physiologic Anemia
 Disproportionate increase in plasma vol, RBC vol. and
  hemoglobin mass during pregnancy
...
Physiologic anemia in pregnancy
Criteria for Physiologic Anemia
 Hb: 10gm%
 RBC: 3.2 million/mm3
 PCV: 30%
 Peripheral smear showing normal morphology...
Significance of Hypervolemia
 . To meet the demands of the enlarged uterus with its
  greatly hypertrophied vascular syst...
 Normal hemoglobin by gestational age in
 pregnant women taking iron supplement

 12 wks       12.2 [11.0-13.4]
 24wks ...
FACTORS LEAD TO DEVELOP ANEMIA
 Physiological hamodilution
  Increase iron demand
  Diminished intake of iron
 Disturbed...
SIGNS AND SYMPTOMS OF ANEMIA
Symptoms
 fatigue,
 Headache
 Faintness
 Breathlessness
 Palpitation
 Intermittent clau...
SIGNS
 Palar of skin , conjunctiva, mucous membrane
 Tachycardia high volume pulse
 Ankle edema
 Cardiac failure
 Sys...
koilonychia
Smooth tounge
Angular cheilosis
EFFECTS OF ANEMIA ON PREGNANCY
MATERNAL EFFECTS
 Preterm labour
 Anasarca
 CCF
 Pulmonary edema
 PPH
 P-Sepsis
 Fai...
 Maternal mortality in 3rd trimester ,during labour ,delivery
  ,immediately after delivery ,during peurperium due to
  h...
DIAGNOSIS OF IRON DEFICIENCY ANEMIA

1.Hb%-
practical cheap early performed method
2.Blood cell indices
-differentiated b/...
Red cell indices in iron deficiency and
     thalasemia
characteristics   calculation    Normal range   Iron deficiency   ...
3.Serum ferritin –reflect iron store
Normal level 15-300microgram /L
Level <12 microgram/L indicate iron deficiency
4.TIBC...
5.Free erythropoietin receptors
Help to differentiate b/w iron deficiency and thalasemia
6.Serum transfferin receptors
App...
bone marrow aspiration
  high cellularity mild to moderate erythroid
    hyperplasia
  (25-35%; N 16 – 18%)
  polychromati...
9.Urine examination- for occult blood
  shistosomiasis in shistosomiasis prevalent
  countries.
10.Blood film for MP
11.Sp...
Iron. Deficiency—Diagnoses

Microphotograph of bone
marrow staining for iron.
Iron is stained blue and it
is mainly in the...
Categorizing iron deficiency anemia
category   Serum ferritin   Hb%       Diagnosis


One        >12mcg/dl        >11g/dl ...
Treatment of iron deficiency anemia
 Medical treatment
 Oral iron
 Parenteral iron
 Blood transfusion
 Recombinant er...
ORAL IRON
 PROPHYLAXIS -100mg(elemental iron)+0.5 folic acid /day
 THERAPUTIC -180mg elemental iron/day
              Ra...
Oral iron
DISAADVANTAGES
 Intolerance to medication
 Unpredictable absorption
 Non compliance
SIDE EFFECTS
 Abdominal ...
Oral iron
INDICATORS OF RESPONSE TO THERAPY
 Improvements in symptoms
 Increase reticulocyte count in 5-10 days
 Increa...
PARENTERAL IRON THERAPY
Available forms
 Iron dextran (oral and i/v infusion)
 Iron poly maltose(sucrofer rubiject)
 Ir...
Total dose infusion
Total dose iron replacement in 2nd and 3rd trimester in
   which
total deficit is calculated and given...
PARENTRAL IRON THERAPY

                   I/M-ROUTE
 Iron sorbitol citrate (jactosol /jectofer)
Advantages
 low mol:wt:...
Precautions
Stop oral iron to avoid toxic effect
Disadvantages
 Nausea vomiting
 Headache
 Fever
 Allergic reaction
 ...
Parenteral iron therapy continue..
             INTRAVENOUS IRON
Indication
 Non compliant
 GI problems
 Pregnancy >32-...
ERETHROPOETIN
Recombinant erythropoietin
 Anemia of chronic renal failure
 Autologous production of blood in normal indi...
Obstetrical treatment
 Frequent A/N visits
 Caution in use of steroids and beta mimetics in p.t.l
 Prop up, oxygen
 Se...
Obstetrical treatment
Antenatal care
 More frequent visit
 Detect and manage complication as heart failure PTL
 Fetal m...
Obstetrical treatment
Management in labour
 Comfortable position (prop up)
 Sedation
 Analgesia
 In pre term beta mime...
Obstetrical treatment
Second stage management
 Shortened by instrumental delivery
Third stage
 AMTSL except in severe an...
Megaloblastic Anemia's
 A form of anemia characterized by the presence of large,
  immature, abnormal red blood cell prog...
Static Test for Folate/B12 Status
Folate
 Measured in whole blood (plasma and cells) and then
  in the serum alone
 Diff...
Functional Tests for
Macrocytic Anemia's
 Homocysteine: Folate and B12 are needed to convert
  homocysteine to methionine...
Pernicious Anemia
A macrocytic, megaloblastic anemia caused by a deficiency of
   vitamin B12.
 Usually secondary to lack...
Symptoms of
Pernicious Anemia
 Paresthesia (especially numbness and tingling in
  hands and feet)
 Poor muscular coordin...
Vitamin B12 Depletion
 Stage I—early negative vitamin B12 balance
 Stage II—vitamin B12 depletion
 Stage III—damaged me...
Causes of Vitamin B12 Deficiency
 Inadequate ingestion
 Inadequate absorption
 Inadequate utilization
 Increased requi...
Treatment of B12 Deficiency
 Before 1926 was incurable; until 1948 was treated with
  liver extract
 Now treatment consi...
Folic Acid Deficiency
 Tropical sprue; pregnancy; infants born to deficient
  mothers
 Alcoholics
 People taking medica...
Causes of Folate Deficiency
 Inadequate ingestion
 Inadequate absorption
 Inadequate utilization
 Increased requiremen...
Methylfolate Trap
In the absence of B12,
folate in the body exists as
5-methyltetrahydro-folate
(an inactive form)
B12 all...
Stages of Folate Depletion and
Deficiency
 Stage I—early negative folate balance (serum depletion)
 Stage II—negative fo...
Diagnosis of Folate Deficiency
 Folate stores are depleted after 2-4 months on
  deficient diet
 Megaloblastic anemia, l...
Other Nutritional Anemia's
 Copper deficiency anemia
 Anemia of protein-energy malnutrition
 Sideroblastic (pyridoxine-...
Hemolytic Anemia
 Oxidative damage to cells—lysis occurs
 Vitamin E is an antioxidant that seems to          be
  protec...
Non nutritional Anemia's
 Sports anemia (hypochromic microcytic transient
    anemia)
   Anemia of pregnancy: dilutional...
SUMMARY
 Anemia is most common medical disorder of pregnancy
  with significant maternal ND fetal implications

 Iron de...
THANK YOU
Anemia in pregnancy by dr shabnam naz
Anemia in pregnancy by dr shabnam naz
Upcoming SlideShare
Loading in …5
×

of

Anemia in pregnancy by dr shabnam naz Slide 1 Anemia in pregnancy by dr shabnam naz Slide 2 Anemia in pregnancy by dr shabnam naz Slide 3 Anemia in pregnancy by dr shabnam naz Slide 4 Anemia in pregnancy by dr shabnam naz Slide 5 Anemia in pregnancy by dr shabnam naz Slide 6 Anemia in pregnancy by dr shabnam naz Slide 7 Anemia in pregnancy by dr shabnam naz Slide 8 Anemia in pregnancy by dr shabnam naz Slide 9 Anemia in pregnancy by dr shabnam naz Slide 10 Anemia in pregnancy by dr shabnam naz Slide 11 Anemia in pregnancy by dr shabnam naz Slide 12 Anemia in pregnancy by dr shabnam naz Slide 13 Anemia in pregnancy by dr shabnam naz Slide 14 Anemia in pregnancy by dr shabnam naz Slide 15 Anemia in pregnancy by dr shabnam naz Slide 16 Anemia in pregnancy by dr shabnam naz Slide 17 Anemia in pregnancy by dr shabnam naz Slide 18 Anemia in pregnancy by dr shabnam naz Slide 19 Anemia in pregnancy by dr shabnam naz Slide 20 Anemia in pregnancy by dr shabnam naz Slide 21 Anemia in pregnancy by dr shabnam naz Slide 22 Anemia in pregnancy by dr shabnam naz Slide 23 Anemia in pregnancy by dr shabnam naz Slide 24 Anemia in pregnancy by dr shabnam naz Slide 25 Anemia in pregnancy by dr shabnam naz Slide 26 Anemia in pregnancy by dr shabnam naz Slide 27 Anemia in pregnancy by dr shabnam naz Slide 28 Anemia in pregnancy by dr shabnam naz Slide 29 Anemia in pregnancy by dr shabnam naz Slide 30 Anemia in pregnancy by dr shabnam naz Slide 31 Anemia in pregnancy by dr shabnam naz Slide 32 Anemia in pregnancy by dr shabnam naz Slide 33 Anemia in pregnancy by dr shabnam naz Slide 34 Anemia in pregnancy by dr shabnam naz Slide 35 Anemia in pregnancy by dr shabnam naz Slide 36 Anemia in pregnancy by dr shabnam naz Slide 37 Anemia in pregnancy by dr shabnam naz Slide 38 Anemia in pregnancy by dr shabnam naz Slide 39 Anemia in pregnancy by dr shabnam naz Slide 40 Anemia in pregnancy by dr shabnam naz Slide 41 Anemia in pregnancy by dr shabnam naz Slide 42 Anemia in pregnancy by dr shabnam naz Slide 43 Anemia in pregnancy by dr shabnam naz Slide 44 Anemia in pregnancy by dr shabnam naz Slide 45 Anemia in pregnancy by dr shabnam naz Slide 46 Anemia in pregnancy by dr shabnam naz Slide 47 Anemia in pregnancy by dr shabnam naz Slide 48 Anemia in pregnancy by dr shabnam naz Slide 49 Anemia in pregnancy by dr shabnam naz Slide 50 Anemia in pregnancy by dr shabnam naz Slide 51 Anemia in pregnancy by dr shabnam naz Slide 52 Anemia in pregnancy by dr shabnam naz Slide 53 Anemia in pregnancy by dr shabnam naz Slide 54 Anemia in pregnancy by dr shabnam naz Slide 55 Anemia in pregnancy by dr shabnam naz Slide 56 Anemia in pregnancy by dr shabnam naz Slide 57 Anemia in pregnancy by dr shabnam naz Slide 58 Anemia in pregnancy by dr shabnam naz Slide 59 Anemia in pregnancy by dr shabnam naz Slide 60 Anemia in pregnancy by dr shabnam naz Slide 61 Anemia in pregnancy by dr shabnam naz Slide 62 Anemia in pregnancy by dr shabnam naz Slide 63 Anemia in pregnancy by dr shabnam naz Slide 64 Anemia in pregnancy by dr shabnam naz Slide 65 Anemia in pregnancy by dr shabnam naz Slide 66 Anemia in pregnancy by dr shabnam naz Slide 67 Anemia in pregnancy by dr shabnam naz Slide 68 Anemia in pregnancy by dr shabnam naz Slide 69
Upcoming SlideShare
Anaemia in pregnancy
Next

293 Likes

Share

Anemia in pregnancy by dr shabnam naz

CONTINOUS MEDICAL EDUCATION BY DR NAZ

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Anemia in pregnancy by dr shabnam naz

  1. 1. ANEMIA IN PREGNANCY DR SHABNAM NAZ ASSISTANT PROFESSOR OBGYN CMC,SMBBMU LARKANA
  2. 2. definition A pathological condition in which the oxygen carrying capacity of red blood cells is insufficient to meet the body ‘s needs WHO recommends the HB% should not fall below 11g/dl at any time during pregnancy CDC refer the value of 10.5 g /dl
  3. 3. PREVALANCE- 40% of world ‘s population (35%non-preg 51%pregnant) 56% in Pakistan MORTALITY 40-60% IN Pakistan 18% in industerlised countries
  4. 4. PHYSIOLOGICAL CHANGES IN BLOOD DURING PREGNANCY  Plasma volume increased 50%  Red cell mass increased 25%  Fall in Hb conc:, haematocrit & red cell count .  MCV increased secondary to erythropoiesis  MCHC remains stable  Sr: iron and ferritin decrease  TIBC increased
  5. 5. Severity of anemia Severity Percentage hemoglobin values MILD 13 10-10.9 mg/dl MODERATE 57 7-10mg/dl SEVERE 12 <7mgldl VERY SEVERE Decompanseted <4mg/dl
  6. 6. Degrees of anemia
  7. 7. CLASSIFICATION of ANEMIA  Physiologic  Pathologic: a. Deficiency: Iron, Folic A., Vitamin B12 b. Hemorrhagic: APH, Hookworm c. Hereditary: Thalassemia, Sickle, H. Hemolytic Anemia d. Bone Marrow Insufficiency: Aplastic Anemia e. Infections: Malaria, TB f. Chronic Renal Diseases or Neoplasm.
  8. 8. IRON DEFICIENCY ANEMIA
  9. 9. IRON ABSORBTION  Dietary iron (heme and non heme) - heme-animal blood flesh viseras -Non heme-cerels, seeds, vegetables, milk eggs.  Factors increases iron absorbtion  Heme iron  Proteins  Meat  Ascorbic acid  Fermentation
  10. 10.  Ferrous iron  Gastric acidity  Alcohol  Low iron stores  Increase erethropiioetic activity(hight altitue,bleeding) FACTROS DECREASES IRON ABSORBTION  Phytates  Calcium  Tennins, tea, coffee, herbal drinks  Fortified iron supplements
  11. 11. IRON LOSS PHYSIOLOGIC FACTORS  Desquamation of cells( intestine, skin)  Menstruation  Delivery  Lactation PATHOLOGIC FACTORS  Hookworms /other helmentis  Bleeding from GIT  Allergies  Occult blood loss, excess menses,APH
  12. 12. Iron requirement in pregnancy  Adult woman absorption-2mg/day  Total iron requirement during pregnancy-900mg DEMANDS  EXPANSION OF RBC-500 -600mg  FETUS AND PLACENTA-300mg DAILY IRON REQUIREMENTDURING PREGANCY 4mg Early pregnancy – 2.5mg 20-32wksof pregnancy- 5.5mg >32wks of pregnancy6-8mg Iron absorption rate 10%
  13. 13. PREVENTION OF IRON DEFICIENCY 1.Iron supplementation during pregnancy According to WHO 60 mg elemental iron and 250mg folic acid daily for 6 months and additional 3 months in postpartum period in low prevalence countries 2.Treatment of hookworm infestation Single dose of albendazole 400mg stat Or mebendazole 100mg BD for 3 days 3.Improvements of dietary habits Iron rich food Cook food in iron utensils
  14. 14. Prevention continue….. 4.Social services Improvement in sanitation Personal hygiene Better education of female regarding diet Contraception 5.Food fortification Iron fortified salt like iodine salt
  15. 15. Concept of Physiologic Anemia  Disproportionate increase in plasma vol, RBC vol. and hemoglobin mass during pregnancy  Marked demand of extra iron during pregnancy especially in second trimester
  16. 16. Physiologic anemia in pregnancy
  17. 17. Criteria for Physiologic Anemia  Hb: 10gm%  RBC: 3.2 million/mm3  PCV: 30%  Peripheral smear showing normal morphology of RBC with central pallor
  18. 18. Significance of Hypervolemia  . To meet the demands of the enlarged uterus with its greatly hypertrophied vascular system. 2. To protect the mother, and in turn the fetus, against the deleterious effects of impaired venous return in the supine and erect positions. 3. To safeguard the mother against the adverse effects of blood loss associated with parturition.
  19. 19.  Normal hemoglobin by gestational age in pregnant women taking iron supplement  12 wks 12.2 [11.0-13.4]  24wks 11.6 [10.6-12.8]  40 wks 12.6 [11.2-13.6]
  20. 20. FACTORS LEAD TO DEVELOP ANEMIA  Physiological hamodilution Increase iron demand Diminished intake of iron  Disturbed metabolism  Pre-pregnancy health status  Excess demand
  21. 21. SIGNS AND SYMPTOMS OF ANEMIA Symptoms  fatigue,  Headache  Faintness  Breathlessness  Palpitation  Intermittent claudication
  22. 22. SIGNS  Palar of skin , conjunctiva, mucous membrane  Tachycardia high volume pulse  Ankle edema  Cardiac failure  Systolic flow murmur Specific signs of iron deficiency koilonychias, brittle nails atrophy of papilla of tongue Angular stomatisis, brittle hair, palmmer winson syndrome
  23. 23. koilonychia
  24. 24. Smooth tounge
  25. 25. Angular cheilosis
  26. 26. EFFECTS OF ANEMIA ON PREGNANCY MATERNAL EFFECTS  Preterm labour  Anasarca  CCF  Pulmonary edema  PPH  P-Sepsis  Failing lactation  Sub involution of uterus  thromboembolism
  27. 27.  Maternal mortality in 3rd trimester ,during labour ,delivery ,immediately after delivery ,during peurperium due to heart failure and pulmonary embolism . FETAL EFFECTS  Pre-term birth  SGA  Infection  Anemia  Low iron store  High peri-natal mortality
  28. 28. DIAGNOSIS OF IRON DEFICIENCY ANEMIA 1.Hb%- practical cheap early performed method 2.Blood cell indices -differentiated b/w iron deficiency and thalasemia
  29. 29. Red cell indices in iron deficiency and thalasemia characteristics calculation Normal range Iron deficiency Thalasemia MCV(fl) PCV/RBC 75-96 Reduced Very reduced MCH(pg) Hb/RBC 27-33 Reduced Very reduced MCHC(g/dl) Hb /PCV 32-35 Reduced Normal or slightly reduced HbF(%) hbF/HbA/100 <2% normal Raised HbA2(%) HbA2/HbA/100 2-3% Normal or Raised raised FEP(microgram/ ____ <35 >50 Normal dl Red cell width High Normal
  30. 30. 3.Serum ferritin –reflect iron store Normal level 15-300microgram /L Level <12 microgram/L indicate iron deficiency 4.TIBC-serum iron decreased and TIBC increased Transferin saturation can be estimated from serum iron and TIBC Reduce transferin saturation indicate deficient iron supply to tissues. Serum iron 60-120 mcg/dl TIBC-300-350mcg/dl
  31. 31. 5.Free erythropoietin receptors Help to differentiate b/w iron deficiency and thalasemia 6.Serum transfferin receptors Appear to be specific and sensitive marker of iron deficiency in pregnancy, its level increased in iron deficiency, but not routinely available. 7.Bone marrow aspiration When no response and for diagnosis of aplastic anemia and kalzar
  32. 32. bone marrow aspiration high cellularity mild to moderate erythroid hyperplasia (25-35%; N 16 – 18%) polychromatic and pyknotic cytoplasm of erythroblasts is vacuolated and irregular in outline (micronormoblastic erythropoiesis)absence of stainable iron 8.Stool examination-consequently for 3 days
  33. 33. 9.Urine examination- for occult blood shistosomiasis in shistosomiasis prevalent countries. 10.Blood film for MP 11.Sputum examination /x-ray (TB) 12.RFT 13.Serum protein(hypo proteienemia)
  34. 34. Iron. Deficiency—Diagnoses Microphotograph of bone marrow staining for iron. Iron is stained blue and it is mainly in the macrophages (lower left
  35. 35. Categorizing iron deficiency anemia category Serum ferritin Hb% Diagnosis One >12mcg/dl >11g/dl Normal no iron deficiency Two <12mcg/dl >11g/dl Storage iron depletion Three <12mcg/dl <11g/dl Iron deficiency Four >12mcg/dl <11gdl Other cause of anemia
  36. 36. Treatment of iron deficiency anemia  Medical treatment  Oral iron  Parenteral iron  Blood transfusion  Recombinant erythropoietin
  37. 37. ORAL IRON  PROPHYLAXIS -100mg(elemental iron)+0.5 folic acid /day  THERAPUTIC -180mg elemental iron/day Raise of Hb-0.3-0.8g/wk To improve compliance 1. Give drug less frequently then daily 2. Change brand 3. Give with meal or decrease dose. If no improvement Another preparation as carbonyl iron Blood transfusion
  38. 38. Oral iron DISAADVANTAGES  Intolerance to medication  Unpredictable absorption  Non compliance SIDE EFFECTS  Abdominal cramps  Constipation  Distaste  Nausea vomiting
  39. 39. Oral iron INDICATORS OF RESPONSE TO THERAPY  Improvements in symptoms  Increase reticulocyte count in 5-10 days  Increase in Hb% 0.8g/dl/week REASONS OF FAILURE  Inaccurate diagnosis  Non compliance  Continues blood loss
  40. 40. PARENTERAL IRON THERAPY Available forms  Iron dextran (oral and i/v infusion)  Iron poly maltose(sucrofer rubiject)  Iron sucrose DOSE (Normal Hb-patient’s Hb) x weight(kg)x2.21 +1000= (14-7) x65kg x 2.21+1000=2005mg Precautions  Should be given in hospital setup by doctor  Inj :hydrocortisone, epinephrine, and oxygen should be available.
  41. 41. Total dose infusion Total dose iron replacement in 2nd and 3rd trimester in which total deficit is calculated and given as single infusion which take 3-6 hrs to complete. Various preparations are available Dextran( imferon)withdrawn b/c of high incidence of anaphylaxis
  42. 42. PARENTRAL IRON THERAPY I/M-ROUTE  Iron sorbitol citrate (jactosol /jectofer) Advantages  low mol:wt:  Rapid absorption Dose and technique  50mg test dose then 100mg i/m  Z technique
  43. 43. Precautions Stop oral iron to avoid toxic effect Disadvantages  Nausea vomiting  Headache  Fever  Allergic reaction  Lymph adenopathy  Tattooing of skin  Severe anaphylaxis
  44. 44. Parenteral iron therapy continue.. INTRAVENOUS IRON Indication  Non compliant  GI problems  Pregnancy >32-36wks Advantages  Certainty of its administration  Raise Hb/wk(rapid raise)  Alternate to blood transfusion when oral treatment fails.
  45. 45. ERETHROPOETIN Recombinant erythropoietin  Anemia of chronic renal failure  Autologous production of blood in normal individuals  Severe postpartum anemia(life saving)  Where blood transfusion avoided as in jehovah witnesses BLOOD TRANSFUSION (pc) preferred  Severe anemia  Pregnancy beyond 36 wks  Blood loss e.g. ; APH,PPH,  Pts not responding to oral and parental treatment EXCHANGE TRANSFUSION  Very rare in sever anemia
  46. 46. Obstetrical treatment  Frequent A/N visits  Caution in use of steroids and beta mimetics in p.t.l  Prop up, oxygen  Sedation  Adequate analgesia  Assisted delivery in second stage  AMTSL  Breast feeding  Contraception for 2 years  Continue iron for 3 months
  47. 47. Obstetrical treatment Antenatal care  More frequent visit  Detect and manage complication as heart failure PTL  Fetal monitoring for growth and well being
  48. 48. Obstetrical treatment Management in labour  Comfortable position (prop up)  Sedation  Analgesia  In pre term beta mimetics and corticosteroids used carefully to avoid risk of pulmonary edema  Antibiotic prophylaxis  Oxygen in dyspnoic patients  Digitalization and cardiac support in cardiac failure.
  49. 49. Obstetrical treatment Second stage management  Shortened by instrumental delivery Third stage  AMTSL except in severe anemic for fear of cardiac failure Puerperium  Adequate rest  Iron and folate therapy for 3 months  Treatment of any infections  Pediatric opinion  Effective contraception.(at least 2 years till iron store recover)
  50. 50. Megaloblastic Anemia's  A form of anemia characterized by the presence of large, immature, abnormal red blood cell progenitors in the bone marrow  95% of cases are attributable to folic acid or vitamin B12 deficiency
  51. 51. Static Test for Folate/B12 Status Folate  Measured in whole blood (plasma and cells) and then in the serum alone  Difference is used to calculate the red blood cell folate concentration (may better reflect the whole folate pool)  Can also test serum in fasting patient B12  Measured in serum
  52. 52. Functional Tests for Macrocytic Anemia's  Homocysteine: Folate and B12 are needed to convert homocysteine to methionine; high homocysteine may mean deficiencies of folate, B12 or B6  Methylmalonic acid measurements can be used along with homocysteine to distinguish between B12 and folate deficiencies (↑ in B12 deficiency)  Schilling test: radiolabeled cobalamin is used to test for B12 malabsorption
  53. 53. Pernicious Anemia A macrocytic, megaloblastic anemia caused by a deficiency of vitamin B12.  Usually secondary to lack of intrinsic factor (IF)  May be caused by strict vegan diet  Also can be caused by ↓gastric acid secretion, gastric atrophy, H-pylori, gastrectomy, disorders of the small intestine (celiac disease, regional enteritis, resections), drugs that inhibit B12 absorption including neomycin, alcohol, colchicine, metformin, pancreatic disease
  54. 54. Symptoms of Pernicious Anemia  Paresthesia (especially numbness and tingling in hands and feet)  Poor muscular coordination  Impaired memory and hallucinations  Damage can be permanent
  55. 55. Vitamin B12 Depletion  Stage I—early negative vitamin B12 balance  Stage II—vitamin B12 depletion  Stage III—damaged metabolism: vitamin B12 deficient erythropoiesis  Stage IV—clinical damage including vitamin B12 anemia  Pernicious anemia—numbness in hands and feet; poor muscular coordination; poor memory; hallucinations
  56. 56. Causes of Vitamin B12 Deficiency  Inadequate ingestion  Inadequate absorption  Inadequate utilization  Increased requirement  Increased excretion  Increased destruction by antioxidants
  57. 57. Treatment of B12 Deficiency  Before 1926 was incurable; until 1948 was treated with liver extract  Now treatment consists of injection of 100 mcg of vitamin B12 once per week until resolved, then as often as necessary  Also can use very large oral doses or nasal gel  MNT: high protein diet (1.5 g/kg) with meat, liver, eggs, milk, milk products, green leafy vegetables
  58. 58. Folic Acid Deficiency  Tropical sprue; pregnancy; infants born to deficient mothers  Alcoholics  People taking medications chronically that affect folic acid absorption  Malabsorption syndromes
  59. 59. Causes of Folate Deficiency  Inadequate ingestion  Inadequate absorption  Inadequate utilization  Increased requirement  Increased excretion  Increased destruction  Vitamin B12 deficiency can cause folate deficiency due to the methylfolate trap
  60. 60. Methylfolate Trap In the absence of B12, folate in the body exists as 5-methyltetrahydro-folate (an inactive form) B12 allows the removal of the 5-methyl group to form THFA
  61. 61. Stages of Folate Depletion and Deficiency  Stage I—early negative folate balance (serum depletion)  Stage II—negative folate balance (cell depletion)  Stage III—damaged folate metabolism with folate- deficient erythropoiesis  Stage IV—clinical folate deficiency anemia
  62. 62. Diagnosis of Folate Deficiency  Folate stores are depleted after 2-4 months on deficient diet  Megaloblastic anemia, low leukocytes and platelets  To differentiate from B12, measure serum folate, RBC folate (more reflective of body stores) serum B12  High formiminoglutamic acid (FIGLU) in the urine also diagnostic
  63. 63. Other Nutritional Anemia's  Copper deficiency anemia  Anemia of protein-energy malnutrition  Sideroblastic (pyridoxine-responsive) anemia  Vitamin E–responsive (hemolytic) anemia
  64. 64. Hemolytic Anemia  Oxidative damage to cells—lysis occurs  Vitamin E is an antioxidant that seems to be protective.  This anemia can occur in newborns, especially preemies.
  65. 65. Non nutritional Anemia's  Sports anemia (hypochromic microcytic transient anemia)  Anemia of pregnancy: dilutional  Anemia of inflammation, infection, or malignancy (anemia of chronic disease)  Sickle cell anemia  Thalassemia's
  66. 66. SUMMARY  Anemia is most common medical disorder of pregnancy with significant maternal ND fetal implications  Iron deficiency is major cause of anemia in pregnancy  Diagnosis should be establish during nd before pregnancy so to treat timely to prevent complications  Screening for iron deficiency in pregnancy is simple
  67. 67. THANK YOU
  • Damfavni

    Nov. 23, 2021
  • snehakeerthi1

    Oct. 23, 2021
  • Osamaahmed249

    Sep. 18, 2021
  • MudasirMagray1

    Aug. 11, 2021
  • ShivamKushwaha41

    Aug. 10, 2021
  • RUMEENAKhan

    Aug. 7, 2021
  • PrincessHeart7

    Jun. 29, 2021
  • ShaziaFayazSiyal

    Jun. 28, 2021
  • LatsameeDouangphoumy

    Jun. 26, 2021
  • Safaalarfi

    Jun. 26, 2021
  • AbdullahJan54

    Jun. 3, 2021
  • srinainaSREENAYANA

    May. 28, 2021
  • SaurabhLakade

    May. 20, 2021
  • saiqanaveed3

    Apr. 22, 2021
  • ZamzamSeedi

    Apr. 8, 2021
  • AngelJasminSJ

    Mar. 22, 2021
  • AsmitaTigga

    Mar. 17, 2021
  • RayatiNeeharika

    Mar. 7, 2021
  • ZohaShamshad

    Feb. 26, 2021
  • DakshinSundar1

    Feb. 19, 2021

CONTINOUS MEDICAL EDUCATION BY DR NAZ

Views

Total views

42,419

On Slideshare

0

From embeds

0

Number of embeds

28

Actions

Downloads

0

Shares

0

Comments

0

Likes

293

×