Anemia in Pregnancy

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1. Introduction
Zawadi Saidi, aged 22 years was a housewife, husband was unemployed. She lived in Utange area near Shanzu in Kilifi district. She was admitted in the labour ward at the Coast Provincial General Hospital on 6/4/2011 at 10.34PM as a referral from a private clinic. On admission, she was in poor general condition. She had laboured breathing and complained of headache, dizziness and palpitations, which had lasted about one week. Her parity was 3+0 gravida 4. Her last menstrual period was on 20/7/2010 and expected date of delivery 27/4/2011, hence gestation was 37 weeks on admission. She had attended her first antenatal clinic visit at a gestation period of 30 weeks. During the visit, antenatal profile revealed haemoglobin level of 7g/dl, urine and stool analysis was normal. HIV test and Khan Test were negative. She was given ferrous sulphate and folic acid to supplement iron and folate levels, and given a return date of one month. She however never tuned up again to the antenatal clinic. On 6/4/2011 she was taken to a private clinic but due to her condition, she was referred to the provincial general hospital where she came in poor condition. She started labour some hours after admission. Physical examination showed signs of pallor on conjunctiva and palms of the hands, facial and pedal pitting oedema. She also had clubbing of finger nails. She had laboured breathing, chest recession and bilateral crepitations on auscultation. A repeat haemoglobin level estimation gave a result of 2g/dl. Blood for grouping and cross match was taken and the obstetrician ordered blood transfusion of three units of packed cells if available otherwise whole blood. This was not available till in the morning at 8.30AM when two units of whole blood were availed. Since admission the patient was put on Oxygen and the head of bed raised. The bed had sidebars to prevent her from falling off. At 8.00AM a vaginal examination was done to assess the onset of labour and the cervix...
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