Anemia occurs in up to one third of the women during the third trimester. The most common causes are
Normally hyperplasia of the red bone marrow occurs during pregnancy and the mass of red blood cells increases. However, a disproportionate increase in plasma volume eventually leads to hemodilution (Schwangerschaftshydrämie): The hematocrit (HCT) increases from 38-45% in healthy, non-pregnant women to about 34% in the late singleton pregnancy and to 30% in the late multiple pregnancy from. In pregnancy, anemia is therefore defined as hemoglobin (Hb) <10 g / dl (hematocrit <30%). If the hemoglobin level at the beginning of pregnancy less than 11.5 g / dl, the women are often treated preventively, because then following hemodilution lowers to <10 g / dL Hb. Despite hemodilution the O2 transport capacity remains normal throughout pregnancy. The hematocrit normally increases immediately after birth again. Anemia occurs in up to one third of the women during the third trimester. The most common causes are iron deficiency Folic acid deficiency obstetrician should Jehovah (probably refuse blood transfusions) as soon as possible examine in consultation with a perinatologist pregnant witnesses of anemia. Symptoms and signs Early symptoms did not occur either, or they are non-specific (eg. As fatigue, weakness, dizziness, low exertion). Other symptoms or complaints are sometimes pallor and significant anemia and tachycardia, or hypotension. Anemia increases the risk of premature birth and post-partum infections of the mother. Diagnostic blood count, followed by tests on the basis of MCV values ??Diagnosis begins with a large blood count; in the presence of anemia further investigations based on whether the MCV (mean corpuscular volume) (<79 fl) or high (> 100 fL) is low. In microcytic anemia: In order to clarify an investigation belongs to iron deficiency (by measurement of serum ferritin) and hemoglobinopathies (by hemoglobin electrophoresis). If these investigations lead to no diagnosis and fails the reaction to be expected on an empirical therapy, an idea is usually justified with a hematologist. In macrocytic anemia: In order to clarify the determination of folic acid and vitamin B12 belongs in serum. In mixed forms: A clarification on both forms is required. Treatment Treatment to make the anemia reversed transfusion as needed for serious symptoms Treatment is directed at eliminating the anemia (s. U.). A transfusion is usually then indicated for anemia if significant being disorders (eg drowsiness, weakness, fatigue.) Or cardiopulmonary symptoms or signs (eg, dyspnea, tachycardia, tachypnea.) Are available; the decision is based on the Hct value. Iron-deficiency anemia in pregnancy About 95% of cases of anemia in pregnancy are due to iron deficiency (iron deficiency anemia). The cause inadequate intake are often (especially among young women) A previous pregnancy achieved with the food, the normal, recurring loss of iron with the menstrual blood (which is approximately the amount that is normally added monthly, and prevents the iron stores located fill) diagnostic measurement of serum iron, ferritin and transferrin Typically, the Hct is ? 30%, and the MCV <79 fL. The diagnosis is po by a decrease in serum iron and ferritin and an increase in transferrin levels bestätigt.Behandlung Typically ferrous sulfate 325 mg once / day, an area occupied in the morning tablet iron sulfate (325 mg) is usually effective. Higher or more frequent doses often the gastrointestinal side effects, especially constipation, and since each dose blocking the absorption of the next dose, the percentage of absorption is thereby reduced. About 20% of pregnant women do not absorb enough of the ingested iron supplementation; some require parenteral therapy, usually iron dextran, i.m. 100 mg every second day to a total dose of 1000 mg for 3 weeks. Hematocrit or hemoglobin should be made weekly to detect treatment response. Remains the iron supplementation ineffective, must also be considered from a folic acid deficiency. Newborns of mothers with iron deficiency anemia usually have a normal hematocrit, but decreased total iron stores and therefore require early of iron supplementation on the Nahrung.Prävention Although this practice is controversial, pregnant women usually receive routine iron supplementation (usually ferrous sulfate 325 mg po 1 times / day) to the depletion of the body's iron stores, which could result from an abnormal blood flow or a subsequent pregnancy prevention. Folic acid deficiency anemia in pregnancy Folic acid deficiency (folic acid deficiency and megaloblastic macrocytic anemias) increases the risk of a neural tube defect and possibly a fetal alcohol syndrome. A deficiency occurs in 0.5-1.5% of pregnant women. In mäßiggradigem or significant deficiency results in a macrocytic, megaloblastic anemia. Rarely, severe anemia and a glossitis develop. Diagnostic measurement of serum folate A folic acid deficiency must be assumed when a macrocytic anemia with indices or with a high red blood cell distribution width (red cell distribution width, RDW) are visible in the large blood image. Low folate levels in serum confirm the Diagnose.Behandlung folate 1 mg p. o. 2 times a day The therapy consists of folic acid 1 mg p.o. 2 times / day. A pronounced megaloblastic anemia justified in some cases, a bone marrow examination and further treatment in Krankenhaus.Prävention Preventive should all pregnant women folic acid 0.4 mg po 1 times get / day. (N. D. Talk .: In Germany, the administration of 0.8 mg [800 ug] per day for the first 8 weeks of pregnancy is recommended, followed by 0.4 mg [400 ug].) Women who have a fetus with spina bifida had, are advised to start 1 time / day before the design with the use of 4 mg. Hemoglobinopathies in pregnancy during pregnancy can hemoglobinopathies, esp. Sickle cell disease sickle cell anemia), HbS / C disease (hemoglobin SC disease), ?-thalassemia and ?-thalassemia (thalassemia), the course for mother and child deteriorate (genetic screening see table: Genetic screening for all ethnic groups). Pre-existing, especially a distinctive, sickle cell anemia increases the mother's risk of infection (most often pneumonia, urinary tract infections and endometritis), pregnancy-induced hypertension, heart failure and pulmonary infarction. Fetal growth retardation, premature birth and low birth weight are common. Almost always takes the anemia progresses pregnancy. The plant sickle cell anemia increases the risk of urinary tract infections, but is not associated with serious pregnancy complications. The treatment of sickle cell anemia in pregnancy is comprehensive. Painful crises should be dealt with effectively. Prophylactic exchange transfusions to stabilize the HbA at ? reduce 60% the risk of hemolytic crises and pulmonary complications, but they are not recommended as a routine procedure, since they increase the risk of transfusion reactions, hepatitis, HIV transmission and blood group isoimmunization. Prophylactic transfusion does not seem to reduce perinatal risk. Indications for therapeutic transfusion are: Symptomatic anemia heart failure Serious bacterial infection Severe complications among the labor and delivery (eg, bleeding, sepsis.) A HbS / C disease may be symptomatic for the first time during pregnancy. The disorder increases the risk of lung infarction, embolism caused by occasionally in the area of ??trabeculae (n. D. Übers .: with the following aseptic bone necrosis and washout microscopic bone particles in the bloodstream). Effects on the fetus are unusual, but when they occur they often include growth retardation. A sickle cell ?-thalassemia is similar to the Hb S / C disease, but rare and rather benign. An ?-thalassemia causes no maternal disease, but in a homozygous fetus occurs and fetal intrauterine death to hydrops during the second or third trimester.