OG12.2 | Anaemia in Pregnancy — Summary & Reflection

KEY TAKEAWAYS

Anaemia in pregnancy is defined as Hb below 11 g/dL (WHO) and affects over half of pregnant women in India. Iron deficiency causes approximately 95% of cases in India; other causes include folate/B12 deficiency (megaloblastic), haemolytic (malaria, sickle cell), and aplastic anaemia. Severity is classified as mild (10–10.9), moderate (7–9.9), severe (<7), and very severe (<4 g/dL). Key investigations are CBC with peripheral smear and iron studies (ferritin, serum iron, TIBC). Management is severity-tiered: prophylactic IFA (60 mg iron + 500 mcg folate daily) for all; oral ferrous sulphate (60 mg TID) for Hb 7–10.9 g/dL; parenteral iron sucrose for severe anaemia, failure of oral therapy, or proximity to delivery; blood transfusion for Hb <7 g/dL in the third trimester or for symptomatic/very severe anaemia. Active management of the third stage with oxytocin 10 IU IM minimises PPH risk. Thalassaemia minor patients must NOT receive empirical iron. Maternal complications include PPH, cardiac failure, and puerperal sepsis; foetal complications include IUGR, preterm birth, LBW, and perinatal mortality.

REFLECT

Consider Meena's case from the opening scenario: she has severe iron deficiency anaemia (Hb 6.2 g/dL) at 32 weeks, with IUGR already established. How would you now approach her differently than a clinician who lacks this structured knowledge? What systemic factors in India contribute to so many women arriving at 32 weeks with Hb below 7 g/dL despite an established national IFA programme? What will you do as a future clinician at the population level — in antenatal clinics you run — to close that gap? Reflect on the interplay between a clinical decision (parenteral iron vs transfusion) and its determinants (Hb at booking, nutrition, antenatal compliance, access to care).