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Back to Gynecology Articles

 Sunday, 30 March 2002 05:30 PM GMT

 

The pregnant woman needs 1000 mg iron all through pregnancy i.e. 3.5 mg/day to maintain iron balance.

 
 

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Anemia in pregnancy is defined as hemoglobin concentration < 10 g/dl during pregnancy and puerperium.  

Introduction

The pregnant woman needs 1000 mg iron all through pregnancy i.e. a daily amount of 3.5 mg to maintain iron balance. The iron requirement in the latter half of pregnancy and for several weeks after delivery increases to about 6-7 mg/day.

It is the most common form of anemia encountered during pregnancy. The incidence is higher in poorly nourished women of low socioeconomic standard.

Causes

  • Depletion of iron stores as occurs in non-supplementation of diet.
  • Multifetal pregnancy
  • Deficient absorption e.g. achlorhydria
  • Bleeding with pregnancy or ankylostoma infestation 

Diagnosis

Symptoms

  • Weakness, loss of concentration
  • Headache and loss of appetite
  • Dyspnea and palpitations 

Examination

  • Pallor (nails, lips, conjunctiva)
  • Pulse: tachycardia and waterhammer pulse
  • Cardiac examination: systolic murmurs
  • Abdominal examination: splenomegaly 

Investigations

Complete blood picture shows a picture of hypochromic microcytic anemia:

  • Low RBC count and hemoglobin 
  • Color index and MCHC are decreased
  • WBC and platelets are normal

Serum iron is decreased

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Treatment

Prophylaxis

Iron supplementation during pregnancy (30-60 mg/day and doubled in the case of twin pregnancy) 

Therapeutic treatment

  1. Diet rich in iron
  2. Oral iron therapy: Iron sulphate, iron gluconate
    • Dose 300 mg tablet tds. 
    • Side effects include constipation with dark stools, nausea and vomiting.
    • Response: Hemoglobin is expected to increase with this therapy at a rate of about 0.3-1 g per week and is continued till the hemoglobin concentration is normalized. 
      The dose is then is reduced to half of the required dose in order to restore the iron stores.
  3. Parentral iron

    A simple method to calculate the needed dose is to give 250 mg elemental iron for each 1 gram hemoglobin below normal. 
    • Indications:
      • Severe iron deficiency anemia when there is a need for a rapid response
      • side effects during oral iron therapy.
      • Patients who can not absorb iron e.g. malabsorption syndrome.
    • Administaration: 

      Iron dextran (imferon) contains 50 mg/ml and could be administered by IV and IM routes.
    • Precautions: 
      • Sensitivity test must be done first with antihistaminic and corticosteroid ampoule. 
      • The maximum dose recommended by the manufacturer is 2 ml (lOOmg)/day 
    • Side effects: 

      Parentral iron is expensive and hazardous when compared with oral therapy. Side effects include; pain, inflammation, phlebitis, fever, arthralgia, hypotension and may be fatal anaphylaxis
  4. Blood transfusion

    Each blood unit raises the hemoglobin % by O.51 gram. 
Author:

Dr. Hesham Al-Inany M.D.

 

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