SEVERE ANAEMIA IN PREGNANCY

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SEVERE ANAEMIA IN PREGNANCY

Ques. 1 How can Anaemia affect pregnancy?

Ans.       Anaemia – means qualitative or quantitative reduction of circulating R.B.C. and / or of percentage of haemoglobin concentration in relation to standard age and sex.

 “Anaemia in Pregnancy” refers to all forms of anaemia encountered during pregnancy. This term includes anaemia occurring independently of pregnancy & also includes precipitated or caused by pregnancy.

Types :

  1. Dimorphic anaemia.
  2. Protein deficiency anaemia.
  • Anaemia due to infections, i.e., Malaria, Worms, Dysenteries, Kala-Azar, Tuberculosis, Pyelitis, Streptococcal infection etc.
  1. Anaemia due to Haemorrhages, i.e., bleeding piles, antepartum haemorrhage, purpura etc.
  2. Haemolytic anaemia.
  3. Hypersplenism, viz. chronic malaria, cirrhosis of liver etc.
  • Hypoplastic and aplastic anaemia.
  • Physiological haemdilution of pregnancy.
  1. Nutritional macrocytic Anaemia.
  2. Iron deficiency Anaemia.

Ques. 2 What are the causes of Anaemia in pregnancy?

Ans.      CAUSES OF ANAEMIA IN PREGNANCY

  1. Repeated childbirth in quick succession.
  2. Bleeding factors – Ante-partum haemorrhage, bleeding gums and piles.
  • Ancylostomiasis or hookworm infestation.
  1. Menorrhagia before pregnancy.
  2. Defective iron absorption, and defective storage of iron.
  3. Defective intake of iron due to nausea and vomiting.
  • Increased demand of the foetus but poor intake.
  • Inadequate antenatal care.
  1. Dietetic deficiency – poor nutrition.

Ques. 3 What are the clinical features of anaemia in pregnancy?

Ans.      CLINICAL FEATURES – In mild and moderate variety the mother does not give any symptoms.

Severe Variety :

  1. C.V.S. – palpitation, dyspnoea, angina attack.
  2. G.I. Tract – anorexia, indigestion, diarrhoea.
  • Neurological – Giddiness or vertigo, insomnia, dimness of vision, tingling and numbness of extremities in pernicious anaemia, lack of concentration.
  1. General – fatigue and lassitude.

On Examination :

  1. C.V.S. – systolic ejection murmur over the base of the heart or over the left second & third intercostals spaces.
  2. Kidney – mild proteinuria.
  • G.I. Tract – enlarged liver & spleen.
  1. Neurological – features of polyneuritis.
  2. General – pallor, oedema of face, lower extremities, ectopic beats, water-hammer pulse, koilonychias in iron deficiency anaemia.

INVESTIGATION – Principle – To note degree of anaemia and the type of anemia and its cause.

  1. Clinical examination.
  2. Thorough clinical and routine laboratory test should be done –
  1. Blood – Hb%, T.C., D.C., R.B.C. count, malaria parasite, P.C.V., M.C.V., M.C.H.C., examination of peripheral blood smear to note the size, shape and central colour of R.B.C., serum albumin, globulin.
  2. Urine – R/E, culture and sensitivity of a mid-stream specimen.
  • Stool – ova, parasite, cyst, occult blood.
  1. X-ray chest – P.A. view – to detect tuberculosis.
  2. Bone-marrow biopsy – done in some selected cases only.
  3. Gastric analysis.
  • Serum iron level, folic acid estimation etc.

Ques. 4 What are the complications of Anaemia in pregnancy?

Ans.      Complications or danger of Anaemia in Pregnancy –

To Mother:

  1. During pregnancy –
    1. Toxaemia – is often precipitated.
    2. Abortion – often due to folic acid deficiency.
  • Acute cardiac failure.
  1. Premature labour.
  2. Accidental haemorrh age- due to folic acid deficiency.
  3. Infection.
  1. During labour –
    1. Collapse occus – following P.P.H.
    2. Shock, whatever may be the cause, is more severe.
  • Cardiac failure.
  1. Uterine inertia.
  1. During Puerperium –
    1. Infection – puerperal sepsis.
    2. Sub-involution.
  • Chronic backache and ill-health.
  1. Venous thrombosis.
  2. Heart failure.

To Foetus – 1. Increased incidence of still-birth. 2. Increased neonatal morality. 3. Prematurity with all its complications.

 

Ques. 5 How can the case of anaemia in pregnancy be managed?

Ans.          MANAGEMENT – General-

  1. Nutrition diet high protein, vitamins and minerals.
  2. Medicines as indicated.
  • Investigations to detect the cause of anaemia.
  1. Response to therapy is to be determined by estimation of Hb% twice weekly.
  2. Treatment of complication, if any.
  3. Absolute bed rest.

Ques. 6 What is the specific treatment in this case?

Ans.          Specific Treatment :

  1. Vitamin B12, Folic acid.
  2. Blood transfusion if (i) where the anaemia not responding to haematinics, (ii) severe infections, (iii) aplastic anaemia, (iv) post-partum haemorrhage. (v) the patient comes very late,
  3. Iron – orally, intra-muscularly, and intravenously.

Ques. 7 What are the preventive measures of Anaemia in pregnancy?

Ans.          Preventive Measures –

  1. Adequate diet.
  2. Family planning.
  • Improvement of standard of living.
  1. Mass education publicity and propaganda.
  2. Early and proper treatment of mild cases.
  3. To treat the cause of anemia.
  • Adequate antenatal care.
  • Routine administration of iron and folic acid.

Ques. 8 Which Homoeopathic medicines are useful?

Ans.      Homoeopathic Remedies –

  1. PETROLEUM – With much sickness, inability to retain any food.
  2. ARSENIC ALB – Anaemia; gastroataxia; extreme restlessness and fear of death. Excessive prostration, with sinking of the vital forces; oedema; wants to be in a warm room.
  3. CHINA – Complaints from loss of animal fluids, be it blood, diarrhoea, leucorrhoea etc.
  4. NUX VOM – Anaemia from gastro-intestinal derangement, esp. in persons of sedentary habits or given to high living.
  5. FERRUM MET – Face ashy pale or greenish, becomes bright red in flushes; great paleness of mucous membranes. Anaemia of chlorotic girls and women.
  6. ARGENTUM NIT – Anaemia with vomiting, acute epigastric pain and tenderness, palpitation and fainting.
  7. PICRIC ACID – Anaemia; with marked indisposition to bodily or mental exertion and great increase of urate and phosphates in the urine.

 

Ques. 9 Which Biochemic remedies are useful?

Ans.      Biochemic Remedies :

  1. FERRUM PHOS – Great debility, trembling, aversion to exercise; palpitation, heaviness of head, with loss of sight, fainting and ringing in ears; sleeplessness; anaemia from prolonged haemorrhage. Morning sickness of pregnancy, with vomiting of food as taken. After pains and as a preventive of fever of lactation.
  2. NATRUM PHOS – Anaemia, accompanied with indigestion acid rising etc. to aid in the proper assimilation with indigestion acid rising etc. to aid in the proper assimilation of food. Intercurrently with Calc. Phos.
  3. CALC PHOS – This remedy supplies new blood-cells. Face pale of chlorotic, greenish-white. Anaemia where nutrition is defective. Excess of white corpuscles in the blood, after wasting or exhausting diseases.
  4. NATRUM MUR – In chlorotic conditions, where the blood is thin and watery, not coagulating, Skin has a dead, dirty look; indicating this salt; constipation.
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