Obstetrics Manual for Merrygold Hospitals - State Innovations in ...

Note:
If recurrent vomiting after Fe supplementation: Change sulfate to fumarate and then to
gluconate
If repeated non-compliance and intolerance ascertained, then parenteral Fe
supplementation may be considered
If Hb% between 5 to 6.9 gm%
In Early pregnancy:
• Admit patient and investigate extensively to exclude serious causes
like malaria, bone marrow abnormalities, thalassemia, chronic bleeding
disorders, marrow abnormalities, leukemias, etc.
• If Iron (Fe) deficiency confirmed and gestation age is :
i. Below 32 weeks - give oral Fe as in 100 mg elemental Fe with
upto 2 mg folic acid upto 12 weeks postpartum.
ii. Between 32 to 36 weeks - parenteral Fe should be given
iii. Over 36 weeks - whole blood transfusion
If Hb% less than 5 gm%
1. Packed cell transfusion with furesemide IV administered 30 mins after
initiating transfusion.
2. If Congestive Cardiac Failure (CCF) - Packed cell transfusion. Urgent
involvement of a physician, which means the physician should be brought
in and provide necessary treatment
Indications of Blood Transfusion for Anemia in Pregnancy
If Pregnancy less than 36 weeks:
a. Haemoglobin 5.0 g/dl or below, even without clinical signs of cardiac
failure or hypoxia
b. Haemoglobin between 5 and 7.0 g/dl and in the presence of the following
conditions:
• Established or incipient cardiac failure or clinical evidence of
hypoxia
• Pneumonia or any other serious bacterial infection
• Malaria
• Pre-existing heart disease, not causally related to the anaemia.
If Pregnancy 36 weeks or more:
a
Haemoglobin 6.0 g/dl or below with of without any other signs and
symptoms
b Haemoglobin between 6.0 g/dl and 8.0 g/dl and in the presence of the
following conditions:
• Established or incipient cardiac failure or clinical evidence of
28