Topic: Labour management, complications of 3rd stage, Antepartum and postpartum
hemorrhage
Question: Enumerate the complications of anemia in pregnancy. Describe the management of a pregnant woman with severe anemia in labor.
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Anemia in pregnancy can lead to several maternal and fetal complications if left untreated. Here is a detailed overview:
Maternal complications:
– Cardiac failure – Due to high output cardiac failure from anemia which can lead to pulmonary edema.
– Preeclampsia – Increased risk of preeclampsia and eclampsia.
– Gestational diabetes – Higher risk of developing gestational diabetes.
– Small for gestational age – Poor oxygen and nutrient delivery can restrict fetal growth.
– Preterm labor – Anemia is associated with increased risk of preterm delivery.
– Postpartum hemorrhage – Increased blood loss during delivery due to reduced hematocrit levels.
– Postpartum infections – Impaired immunity increases the risk of chorioamnionitis, endometritis, UTI, wound infections.
– Fatigue and reduced quality of life.
– Increased need for blood transfusion.
– Mortality – Significant maternal mortality risk from severe anemia.
Fetal complications:
– Intrauterine growth restriction (IUGR)
– Intrauterine fetal demise (IUFD)
– Low birth weight
– Preterm delivery
– Perinatal mortality
– Impaired neurocognitive development
Management of severe anemia in labor:
– Evaluate severity – Check hemoglobin, hematocrit, peripheral smear, etc.
– Determine cause – Iron deficiency, folate/B12 deficiency, hemoglobinopathy etc.
– Start IV hydration – With isotonic fluids to maintain preload.
– Oxygenation – Give oxygen by face mask at 8-10 L/min.
– Transfuse PRBCs – If Hb <7 g/dl, transfuse premixed PRBCs urgently.
– Monitor vitals – Heart rate, BP, respiratory rate, urine output. Watch for fluid overload.
– Fetal monitoring – Use cardiotocography to monitor fetal heart rate and contractions.
– Low threshold for C-section – Avoid pushing and valsalva if severe anemia.
– Postpartum monitoring – For 24 hours for fluid shifts, vital signs, PPH.
– Further workup – For underlying cause; treat specifically.
– Education on contraception and optimal birth spacing.
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