ANAEMIA IN PREGNANCY

The world health organisation (WHO) index for anaemia in pregnance is when the haemoglobin level in the peripheral blood is Hg/dl or less. However, from practical experience in tropical obstetrics it is generally accepted that anaemia in pregnancy Exist when the Haemoglobin level is less than in loglde or the packed cell volume less than 30%

EPIDEMOOGY:
Anaemia in pregnancy presents a world-wide problem but it is uncommon in developed world. the importance of anaemia in pregnancy in the tropics lies firstly in its greatly increased incidence, and secondly in the seventy of the anaemia with which the patients commonly present for treatment. Both combine to make this complication of pregnancy a major cause of matanal and fetal death in the tropics. A third important problem posed by anaemia in the tropics is polymorphism. In almost all cales, the anaemia is caused by multiple factors whole individual importance varies from area to area. This makes rational prophylaxis and treatment much more difficult. Complicaion of pregnancy in the for at belt of West Africa, between January and April 1955. it was directly responsible for more than 20% of all matanal deaths in patients under the car of the Department of obstetrics, university college Hospital, Ibadan. It also contributed to many other deaths from Antepartum haemorrhage, postpartum haemorrhage and puerperal sepsis. In Nigeria it is a frequent complication, its incidence is high and its severity is staggering. The clinical feathers of anaemia in pregnancy in Nigeira are different from those encountered in temperate countries not only because of the severity of symptoms but also because of the concomitant autuminosis such as marked glossitis, Angular stomatitis and associated gross hepatomegly. Agbola A. (1991)

CLASSIFICATION
Anaemia in pregnancy could be mild, moderate or severe based on the haemoglobin level in the peripheral blood as well as the clinical manifestations and the management would differ for each.

TYPES OF ANAEMIA HB LEVEL
Mild Anaemia in pregnancy 9-Hg/dl
Moderate Anaemia in pregnancy 7-9g/dl
Severe Anaemia in pregnancy 7g/dl

PATHOPHYSIOLOGY
For haemoglobin and Red blood cell synthesis, iron, folate, vitamin Biz and Vitamin c, trace elements like cobate and copper, and proteins are required. Erythroporetin produced by the renal parenchyma stimulates the bone marrow to increase erthropesis which is one of the noticeable physiological changes in pregnancy. Barnes, F.C (1994).
In the non-pregnant female, the total body is about 3.5-kg. 2/3 of this is Haemoglobin another ¼ is in the body stores and the remaining is in the tissue and plasma. Iron is stored in the liver and spleen as femitin and in bone marrows haemosiderin. Iron in the serum is bound to transfer in, a B1 – globulin and transfers is only 1/3 saturated with iron. A good diet provides about 10-15mg of iron per a day and only 10% of this is absorbed. Iron is mainly absorbed in the duedenuim and to some extent in the upper jejunum. The absorption is influenced by dietary phosphates, phytaces, ascorbic acid, sugars especially frutole, Hell in the stomach and gastric factors namely factors I, II and II, iron is lost in the bile, urine, fences, sweat and during menstruation. About 1-2mg of iron is lost daily.
In normal pregnancy, iron demand is increased many folds. The fetus need about 350mg, the placenta about 100mg: the increased material haemoglobin mass about 350mg and that from lactation about 150mg. In adding the pregnant women still excretes iron but on the credit side about 225mg of iron is available as a result of the amenorrhea of pregnancy is about 15%. The increased iron requirement is not uniformly spread over the period of pregnancy but as pregnancy advances from 28 weeks onwards, the increased demand is noticed as a resultant drop in PCV or HB concentration it no iron supplementation has been given Abidu, O, Sofola (1990).

COMPLICATIONS
In the absence of effective treatment, anaemia develops progressively as the pregnancy advances.
The following complications may occurs;
I. CONGESTIVE CARDIA FAILURE: This is the main effect of anaemia muscle oxygen lacse. The most dangerous period is during the first 12 hours after delivery.
II. SHOCK: Severely anaemic women readity go into shock as a result of very small amount of blood loss and motality in such patients.

TREATMENT
This disease cannot be cured, but can be managed for some extent. Air travel during pregnancy should be avoided, especially in unpressurised air crafts sinle the resultant anorexic may cause splenic or other vital organ infection of anaemic pregnant women in our environment should be examined for worms and ova of hookworm. However infestation of hookworm can be prevented by good food and personal hygiene and also protecting the slein from penetration for the worms by wearing fast wears.
Blood transfusion is given with caution in cases where the anaemia is severe, that is HB less than 5g/dl or PCV less than 5% or in cases where moderate anemia co-existing with seplis or Haemorrhage is discovered late after 36 weeks or in labour or immediate pos-partum