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Reported rates of anaemia in pregnancy are very high in
dev eloping countries and ra nge from 20 to 90% of all pregnant
patients seen at antenatal clinics [1 46,148] . The situation is
particular ly poor i n s ub -Saharan Africa where a higher
prevalence of anaemia a nd severity rates are reported [ 146] .
The causes of a naemia i n these r eg i ons are multiple and
include inadequate nutrition, infections including malaria ,
a nd the h e mog l obinopa t h i es (91 , 146, 148 -155].
For various reasons, a great many pregnant women in these
regions, do not receive adequate antenatal c a r e , and t he r e f or e
have no treatment: for their anaemia, and thus enter labour
with compromised haemoglobin levels. In Chad and Casablanca ,
Morocco, f or e xample, 25% a nd 18% of pregnant women
r espective ly s een at the time of de l i ve r y we r e observed to be
anaemic [ 152 , 156]. If a t the time of delivery the s e women do
not r eceive a deq uate l a bour management then e xcessive blood
l os s could occur. If they do not succumb to t he direct effects
of t orrenti a l blood loss , they face a puerper ium complicated
by severe an aemia.
Excessive postpartum haemorrhage is defined as post­
partum blood loss in excess of 500 mls [43]: for most
practising phys i c i an s and midwives, this level also marks the
beginning of concern. Repeated scudLee however have shown that
blood volume losses often es t I me t.ed or recorded i n b i r t h i ng
units are much less than the accurately mea s ur e d levels of