Anemia, Bleeding, Breast problem, Constipation during Pregnancy

Anemia in pregnancy: -

World Health Organization(WHO) in 1972 decided that during pregnancy, if hemoglobin level in blood comes below 11 gm%, the case will be diagnosed as Anemia in Pregnancy.

Factors of Haemopoiesis (formation of blood) –

a) Minerals- Iron, Copper, Cobalt.

b) Vitamins- Vitamin B12, Folic Acid, Vitamin C

c) Protein

d) Erythropoietin- a hormone.

Causes-

A. Physiological

Disproportionate increase in plasma volume during pregnancy leads to apparent reduction of RBC, hemoglobin and hematocrit level.

Lower limit of physiological anemia is RBC up to 3.2 million/ Cmm, normocytic and normochromic red cells and hemoglobin up to 10 gm%. Iron deficiency contributes to the fall in blood vessels. Therefore, there is need for prophylactic iron therapy, which can improve physiological anemia.

B. Acquired

a) Nutritional anemia

Iron deficiency anemia

Commonest cause.

Nutritional Microcytic anemia

Due deficiency in Folic Acid and/or folic acid.

Dimorphic anemia

Protein deficiency anemia

Symptoms of Nutritional anemia- commonly asymptomatic. Fatigue, asthenia, exertional dyspnea sometimes occur. In severe cases, loss of appetite, diarrhea, breathlessness, palpitation on exertion, swelling of face and feet.

Signs- pallor, slight glossitis. In severe cases- marked pallor can be seen on palpebral conjunctiva, tongue, skin. Slight edema of feet or anasarca. Marked glossitis, cardiac dilatation, hemic murmur at heart. Heart failure.

Management

Oral iron. Prophylaxis 60mg. of elemental iron a day taken with meal after first three months of pregnancy. Addition of 500μg of Folic acid a day helps in prevention of folic acid deficiency as well.

Fresh green vegetables, fruits, egg, meat, liver should be taken.

Bleeding in pregnancy: -

In early pregnancy

Spotting.

The main cause for bleeding per vagina is Threatened abortion. It is the type of abortion without passage of tissue but possibility of continuation of pregnancy.

Symptoms- amenorrhea, scanty bright red bleeding or blood stained discharge, no abdominal pain, no history of expulsion of a fleshy lump PV.

Signs- pregnancy breast sign present. Gravid uterus is palpable. Cervical os is closed. Stained discharge is present.

Diagnosis- Pelvic Ultrasound, MRI

Treatment- Complete bed rest. Sterile pad is to be used. If any lump is discharged, one should promptly report to doctor.

Other conditions of bleeding PV are abortion, ectopic pregnancy, hydatidiform mole.

In late pregnancy

The main causes are Placenta previa, Abruptio placente,

In both the cases, position of placenta is much lower than the original site. In very low lying placenta, severe bleeding occurs.

Treatment- Complete bed rest.

Breast problem

Discharge from the nipple is a common sign and in pregnant woman is also less worrisome but it should be evaluated by a doctor. Pain on the breasts is a very common and nonspecific problem in both pregnant. During pregnancy, the breasts enlarge; they become heavier and the blood supply increases. This makes it harder to feel lumps and makes it very important that a woman have a good breast exam early in pregnancy.

Constipation

This is mainly due to the hormone progesterone, which reduces the movement of food through the digestive tract. The problem may further be increased later in pregnancy by the pressure of the growing uterus over the rectum. Iron supplements can make constipation worse.

Eat fiber rich foods such as cereals, whole-grain breads, and fresh fruits and vegetables every day. Add a couple of tablespoons of unprocessed wheat bran to your cereal in the morning and follow it with a glass of water.

Take plenty of water.