Report 2011 - Deepalaya

BLOOD LOSSES
Blood volume increases of about 45 % 41 during normal pregnancy and blood loss is much more harmful for
women suffering from anemia or other conditions than for healthy women. Moreover, we notice that some
conditions that lead to anemia also contribute to complications of pregnancy and delivery. Hemorrhage in the
first third of pregnancy may be caused by spontaneous abortion. In such case, abdominal pain will also be
present. Infection, hemorrhage and deficient cervix may occur due to abortion. Bleeding during second and
third part of pregnancy may occur if placenta is too close to cervix and this might happen to women having
several pregnancies, having pregnancy at an old age or for those who have ever had a caesarian procedure.
Another cause of bleeding during late pregnancy is early removal of placenta from the uterus and etiologic
factors include high parity, age of pregnancy and other conditions such as hypertension. Severe hemorrhages
may also occur and fetus mortality risk is increased. These condition needs close check-ups and delivery in
specialized hospital as complication such as hemorrhages are likely to occur and transfusion of blood should be
given in that case. Postpartum hemorrhages (PPH) are in an increased frequency in the developing world mainly
due to the lack of experienced caregivers who might not be able to manage PPH if it occurred. Lack of available
medication is also to consider. In a home delivery, no one is able to manage correctly those serious
complications if happened. Institutional deliveries are really to promote.
OUTCOMES OF ANEMIA ON MOTHER AND BABY'S HEALTH
Iron deficiency anemia increases the risk for low birth weight, premature delivery, perinatal and neonatal
mortality, postpartum hemorrhages, puerperal sepsis and thrombotic phenomena for the mother 42 , inadequate
iron stores for the newborn, lowered physical activity, fatigue and increased risk of maternal morbidity.
Institutional delivery is even more important in this condition as complications are likely to occur.
A new-born weighting less than 2500g is considered to have a low birth weight (LBW). About 28 per cent of all
babies born in India have LBW and they mainly suffer from fetal growth retardation as compared to only 4 per
cent in some developed countries (mainly a preterm consequence). Maternal malnutrition, before and during
pregnancy, and anemia are known to be significant risk factors in the occurrence of LBW 43 . It is proven that a
woman who has been correctly nourished during infancy has better chances to deliver a baby with a normal
size even if she has not taken an adequate diet during her pregnancy 44 . There are also reasons to believe that
the lower average birth-weight of a new-born baby in developed countries wouldn’t be due to genetic factors
but largely due to maternal malnutrition 45 . Others causes of LBW are hard physical labour during pregnancy,
illnesses especially infections, short maternal stature, very young age, high parity, smoking and close birth
intervals. These factors are all associated and interrelated.
Anemia represented 19 % (22% deaths due to IDA 46 ) of all causes of maternal mortality in 1998 according to
the Family Welfare Survey 47 Thus it is responsible for almost a quarter of maternal deaths 48 . Many social factors
that contribute to anemia are also associated with higher maternal and child mortality rate in India, as for
examples, young age at child birth (below the age of 19 years old 49 ), or relatively older (over 30 years), high
41 Reference 19- p.18
42 Reference 2- p. 452
43 Reference 2- p.552
44 Reference 2- p. 490
45 Reference 2- p. 458
46 Reference 6
47 Reference 7- p. 35
48 Reference 13- p. 7
49 Reference 2- p 490