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 was found to be 7CM dilated and the membranes were bulging. Artificial rupture was done, clear liquor was drained and there was no cord prolapse. The mother was therefore anticipated for a vaginal delivery. During transfusion vital signs observations were done half hourly with no significant deviations noted. After the first unit of blood (10.15AM) the mother’s condition was getting worse and the doctor ordered intravenous lasix 80mg stat, intravenous aminophylline 250mg slowly. Things seemed to be worsening and at 10.30AM the mother started gasping, 20 minutes after commencement of the second unit blood. Cardio-pulmonary resuscitation was instituted and the anaesthetist was called to assist but when he arrived, the mother had no cardio-pulmonary activity. He certified the death and the body was put aside for last offices. The objectives of the study included:

i. to confirm anaemia in pregnancy as a cause of maternal mortality in Coast Provincial General Hospital ii. to evaluate the management offered to antenatal mothers with anaemia in pregnancy iii. to determine the outcome of poorly managed anaemia in pregnancy The study would offer a comparison between documented information and the case scenario.

2. Literature review
Anaemia is a reduction in the oxygen carrying capacity of the blood. Types:
The common types of anaemia that may occur in pregnancy include: i.Anaemia of pregnancy whereby a woman’s blood volume increases by as much as 50%. This causes haemodilution but is not considered abnormal unless the levels fall too low. ii.Iron deficiency anaemia

This is the most common type of anaemia in pregnancy. During pregnancy, there is increased demand for iron, as the fetus uses the mother’s red blood cells for growth and development especially in the last three moths. Deficiency occurs if the mother did not have excess red blood cells stored in bone marrow before she conceived. The stored iron is used to help meet the baby’s needs....
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