Anemia and pregnancy of
Anemia is characterized by decrease in level of hemoglobin in blood, reduction of quantity of erythrocytes (red blood cells), emergence of their pathological forms, and also change of vitamin balance, decrease in an organism of quantity of minerals and enzymes. Anemia is one of the most frequent complications of pregnancy. The leading symptom of anemia at pregnant women is decrease in level of hemoglobin less than 110 g/l. Anemia at pregnant women in 90% of cases is iron deficiency. Such anemia is characterized by violation of synthesis of hemoglobin from - for the deficiency of iron developing owing to various physiological and pathological processes. According to WHO data the frequency of iron deficiency anemia at pregnant women fluctuates from 21 to 80%. Existence of iron deficiency anemia leads to violation of quality of life of patients, reduces their working capacity, causes functional frustration from many bodies and systems. At deficiency of iron at pregnant women the risk of development of complications in labor increases, and in the absence of timely and adequate therapy there can be a deficiency of iron and at a fruit.
In a human body about 4 g of iron which belongs to one of the elements, vital for an organism, are. It is a part of hemoglobin and some other the vital substances of various bodies and systems influencing function in a human body. 75% of iron of a human body are in hemoglobin. Iron from products of an animal origin (meat) is most fully acquired, it is much worse from food of vegetable character. Release of iron from products decreases at their thermal treatment, freezing and long storage.by
removes iron from the woman`s organism in number of 2 - 3 mg a day through intestines, bile, with urine, through slushchivayushchiysya a skin epithelium, at a lactation and periods.
At not pregnant women the need for iron makes 1,5 mg a day. During pregnancy the need for iron steadily increases in the I trimester on 1 mg a day, in the II trimester - on 2 mg a day, in the III trimester - on 3 - 5 mg a day. For production of additional iron 300 - 540 mg of this element are used. From them 250 - 300 mg of iron 50 - 100 mg - on creation of a placenta are spent for needs of a fruit, 50 mg of iron are laid off in a miometriya. Loss of iron is most expressed in 16 - 20 weeks of pregnancy that coincides with the period of the beginning of process of blood formation at a fruit and increase in mass of blood at the pregnant woman. In the third period of childbirth (at physiological blood loss) from 200 to 700 mg of iron are lost. Further, in the period of a lactation, about 200 more mg. Thus, from parent depot during pregnancy and in the postnatal period about 800 - 950 mg of iron are spent. The organism is able to restore iron reserves within 4 - 5 years. If the woman plans pregnancy before this term at it inevitably anemia develops. Deficiency of iron cannot but arise at the multigiving birth women.
some indicators (are presented in the table) peripheral blood depending on pregnancy terms are of Interest.
Some indicators of peripheral blood in various trimesters of pregnancy
|Indicators||1 trimester||2 a trimester||3 a trimester|
|Hemoglobin, g/l||131(112 - 165)||126(110 - 144)||112 (110 - 140)|
|of Gematokrit, %||33||36||34|
|Erythrocytes, 1012 / the l||10,5||10,4|
|of SOE of mm/hour||24||45||52|
Prevention of anemia, first of all, needs to be carried out by
the Factors promoting development of iron deficiency anemia
- Decrease in intake of iron in an organism with food (a vegetarian diet, anorexia).
- Chronic diseases of internals (rheumatism, heart diseases, pyelonephritis, hepatitis). At diseases of a liver there is a violation of processes of accumulation of iron in an organism and its transportations. The special attention should be paid to diseases zheludochno - an intestinal path. Zheludochno - intestinal bleedings at stomach ulcer of a stomach and 12 - a perstny gut, hemorrhoids, and also divertikulez intestines, nonspecific ulcer colitis, a helminthic invasion lead to an anemization of patients.
- Existence of the diseases which are shown chronic nasal bleedings (trombotsitopatiya, trombotsitopenichesky purple).
- the Gynecologic diseases which are followed by plentiful periods or uterine bleedings, endometriosis, uterus myoma.
- the Burdened obstetric anamnesis: the multigiving birth women; spontaneous abortions in the anamnesis; bleedings in the previous labor, promote exhaustion of depot of iron in an organism.
- the Complicated course of the real pregnancy: polycarpous pregnancy; early toxicosis; early age of the pregnant woman (17 years are younger); pervorodyashchy are more senior than 30 years; arterial hypotonia; an exacerbation of chronic infectious diseases during pregnancy; gestoz; prelying of a placenta; premature otsloyka of a placenta.
at the following forms of diseases of blood and system of blood formation: chronic iron deficiency anemia of III - degree IY; hemolytic anemia; hypo - and a marrow aplaziya; leukoses; Verlgof`s illness with frequent aggravations. In case of approach of pregnancy at these diseases it is expedient to interrupt pregnancy till 12 weeks.
to Development of anemia at pregnancy are promoted: the metabolic changes happening in the patient`s organism during pregnancy; decrease in concentration of a number of vitamins and minerals - cobalt, manganese, zinc, nickel; change of hormonal balance of pregnancy time, in particular, increase in quantity of the estradiol causing oppression of an eritropoez; deficiency in an organism at the pregnant woman of B12 vitamin, folic acid and protein; lack of oxygen at which there is a violation okislitelno - recovery processes in the woman`s organism; the immunological changes in the pregnant woman`s organism happening due to continuous anti-gene stimulation of a maternal organism from fabrics of the developing fruit; an iron consumption from depot of an organism of mother, necessary for the correct development of a fruit.
during pregnancy so-called, physiological or “false“ anemia can take place and. Emergence of this form is caused by uneven increase in separate components of blood. The matter is that during pregnancy as compensatory reaction, happens increase by 30 - 50% of volume of blood of mother, but generally for the account for the account of plasma (liquid part of blood). Respectively, the ratio of volume of uniform elements of blood (including the erythrocytes containing hemoglobin) and liquid part of blood (plasma) is displaced towards the last. Such form of anemia does not demand treatment.
Pathological forms of anemia at pregnancy
- the Essentsialny (cryptogene) malignant anemia Birmer - Ehrlich (synonyms: megaloblastichesky anemia, pernitsioznopodobny anemia, anemia Adisson - Birmera). Such anemia meets seldom during pregnancy. This form of anemia is connected with deficiency of B12 vitamin or folic acid. Development of the anemia connected with deficiency of B12 vitamin is promoted by the postponed infections, insufficiency of intake of this vitamin C food, diseases of a stomach both 12 - and a perstny gut, use of medicines (an acyclovir, anticonvulsive preparations, nitrofurans, oral contraceptives) and an illness Krone.
- the Gipokhromny anemias which are associated diseases during pregnancy. Anemia can be a consequence or the accompanying pathology at infectious diseases (sepsis) and parasitic invasions (helminthoses, malaria) during pregnancy. Gipokhromny anemia during pregnancy can result from a disease of a liver, a stomach, alimentary dystrophies.
- of Megaloblastnaya the anemia connected with deficiency of folic acid makes 1% of all anemias of pregnant women, develops in the III trimester of pregnancy, before childbirth and in the early postnatal period more often. Folic acid plays an important role in many physiological processes, participates in synthesis of a number of amino acids, plays a key role in cell division processes. Fabrics with a high speed of cell fission (marrow, mucous intestines) are characterized by the increased need for folic acid. Deficiency of folic acid in an organism arises from - for: insufficient contents it in a diet; the increased need for folic acid (pregnancy, prematurity, gemoliz, cancer); violations of absorption and its increased removal from an organism (some skin diseases, liver diseases). The daily need of an organism of the pregnant woman for folic acid increases up to 400 mkg, and to the term of childbirth - up to 800 mkg, the need for folic acid in the period of a lactation makes 300 mkg. The hidden deficiency of folic acid is noted to 1/3 from total number of pregnant women. Deficiency of folic acid adversely influences the course of pregnancy and development of a fruit. Full formation of nervous system of a fruit is impossible at deficiency of folic acid in the woman`s organism. At such deficiency formation of defects of a nervous tube is possible (an anentsefaliya, to the entsefalotsela, spina bifida). Other important fact confirming a role of folic acid during pregnancy is existence of close interrelation between the level of folic acid in an organism of mother and the mass of the child at the birth. Several weeks prior to the birth the fruit spends folic acid of mother for increase in own weight and replenishment of the stocks of folat. As a result at the women having deficiency of folic acid, probability of the birth of the child with a hypotrophy and the lowered reserve of folic acid significantly increases. The main sources of folic acid in food are: crude green vegetables and fruit (especially oranges), beef liver.
- Hypo - or aplastic anemia at which there is a sharp oppression of marrowy blood formation. Most often are the reasons of this form of anemia: ionizing radiation; reception of medicines (levomitsetin, aminazine, butadion, cytostatics); receipt in an organism of the chemicals (benzene, arsenic) possessing miyelotoksichesky action; chronic infectious diseases (viral hepatitis, pyelonephritis); autoimmune processes. The diagnosis is established on the basis of results of a puncture of marrow in which the total disappearance of marrowy elements and replacement with their fatty tissue and hemorrhages is defined. The lethality for the pregnant woman at this form of anemia reaches 45%. Therefore interruption of pregnancy in terms up to 12 weeks with the subsequent splenektomiya is expedient. If hypoplastic anemia is diagnosed in late terms of pregnancy, the operational rodorazresheniye by operation Cesarean section in a combination to a splenektomiya is recommended.
- Hemolytic anemias - big group of diseases which main distinctive symptom is shortening of life of erythrocytes owing to their gemoliz. Allocate two main groups: hereditary and acquired.
- of Mikrosferotsitarnaya hemolytic anemia has hereditary character. Develops owing to defect of structure of a membrane of an erythrocyte that leads to penetration into a cage of excess of sodium and water accumulation. Erythrocytes gain spherical shape and collapse in a spleen.
- Autoimmune hemolytic anemia at which there is a formation of antibodies to own erythrocytes. Distinguish symptomatic and idiopathic autoimmune hemolytic anemia. Anemia which develops against gemoblastoz, a system red volchanka, ulcer colitis, chronic hepatitis, malignant belongs to a symptomatic form. Carry those cases of anemia when it is impossible to establish the main disease to an idiopathic form. During pregnancy meets seldom. The forecast for mother favorable. Rodorazresheniye - in natural patrimonial ways.
- True iron deficiency anemia which meets during pregnancy most often. Characteristic of this form is either absolute reduction of quantity of erythrocytes, or functional insufficiency of system of erythrocytes. Clinical displays of iron deficiency anemia are caused, on the one hand, by existence of an anemichesky syndrome, with another - deficiency of iron.
Symptoms of an anemichesky syndrome
the Anemichesky syndrome is shown by a complex of nonspecific symptoms and is caused by insufficient oxygen providing fabrics. The main clinical displays of this pathology are the general weakness, increased fatigue, dizziness, noise in ears, flashing of front sights before eyes, tachycardia, short wind at physical activity, unconscious states, sleeplessness, a headache and decrease in working capacity.
are a Consequence of deficiency of iron: dryness of skin, education of cracks on it; violation of an integrity of epidermis; emergence in corners of a mouth of ulcerations and cracks with an inflammation of surrounding fabrics; changes from nails (fragility, lamination, a cross ischerchennost, nails become flat, take the concave spoon-shaped form); damage of hair (hair split, their tips are stratified). At patients in connection with deficiency of iron the language burning sensation is noted; a taste perversion (the desire is chalk, toothpaste, ashes, clay, sand, crude grain); unhealthy addiction to some smells (acetone, gasoline, kerosene, naphthalene); difficulty when swallowing dry and firm food; emergence of feeling of weight and pains a stomach, as at gastritis; an urine incontience at cough and laughter, night enuresis; muscular weakness; pallor of skin; arterial hypotonia; subfebrilny temperature. At a severe form of iron deficiency anemia the anemichesky miokardiodistrofiya develops.Complication of a course of pregnancy at iron deficiency anemia
Because at pregnancy consumption of oxygen increases by 15 - 33%, the expressed fabric hypoxia with the subsequent development of secondary metabolic frustration is characteristic
of pregnant women with iron deficiency anemia that can be followed by development of dystrophic changes in a myocardium and violation of its sokratitelny ability. Iron deficiency anemia is characterized by violations of a proteinaceous exchange with emergence of deficiency of proteins in an organism that leads to development of hypostases in the pregnant woman. At iron deficiency anemia dystrophic processes in a uterus and in a placenta which lead to violation of its function and formation of placentary insufficiency develop. At the same time the developing fruit does not receive the nutrients relying it and oxygen in enough owing to what there is a fruit arrest of development. The main complications of pregnancy at iron deficiency anemia are: pregnancy interruption threat (20 - 42%); gestoz (40%); arterial hypotonia (40%); premature otsloyka of a placenta (25 - 35%); fruit arrest of development (25%); premature birth (11 - 42%). Childbirth often is complicated by bleedings. In the postnatal period there can be various inflammatory complications (12%). by
Krom of an assessment of standard indicators on clinical blood test (hemoglobin, erythrocytes, gematokrit, SOE), diagnosis of iron deficiency anemia is based on an assessment of some other indicators, such as: a color indicator, average content of hemoglobin in an erythrocyte, a morphological picture of erythrocytes, iron level in blood serum, the general iron - the connecting ability of serum of blood, and some other.
of Dietsand for pregnant women with iron deficiency anemia
Pregnant with iron deficiency anemia except drug treatment appoint also a special diet. From food 2,5 mg of iron a day while from medicines - in 15 - 20 times more are soaked up. The greatest number of iron contains in meat products. The iron which is contained in them is soaked up in a human body for 25 - 30%. Absorption of iron of other products of an animal origin (eggs, fish) makes 10 - 15%, of vegetable products - only 3 - 5%.
the Greatest number of iron (in mg on 100 g of a product) contains in pork liver (19,0 mg), cocoa (12,5 mg), an egg yolk (7,2 mg), heart (6,2 mg), calf`s liver (5,4 mg), stale bread (4,7 mg), apricots (4,9 mg), almonds (4,4 mg), indyushiny meat (3,8 mg), spinach (3,1 mg) and veal (2,9 mg). The pregnant woman with iron deficiency anemia has to adhere to a rational diet. From proteinaceous products are recommended: beef, bull liver, language, liver and heart, bird, eggs and cow`s milk. Fats contain in: cheese, cottage cheese, sour cream, cream. Carbohydrates have to be filled for the account: rye bread of a rough grinding, vegetables (tomatoes, carrots, garden radish, beet, pumpkin and cabbage), fruit (apricots, grenades, lemons, sweet cherry), dried fruits (dried apricots, raisin, prunes), nuts, berries (currant, dogrose, raspberry, strawberry, gooseberry), grain (oat, buckwheat, rice) and bean (haricot, peas, corn). Surely have to join in food fresh greens and medical
Prevention and treatment of iron deficiency anemia, use of medicines a zhelezaneobkhodimy condition of treatment of iron deficiency anemia is use of medicines of iron which are appointed only by the attending physician. For prevention of development of iron deficiency anemia during pregnancy the same preparations, as for treatment of this complication are used. Prevention of development of iron deficiency anemia in pregnant women of risk group on developing of this pathology, consists in purpose of small doses of preparations of iron (1 - 2 tablet a day) within 4 - 6 months, since 14 - 16 weeks of pregnancy, courses for 2 - 3 weeks, with breaks for 14 - 21 day, only 3 - 5 courses for pregnancy. It is at the same time necessary to change a diet in favor of increase of the use of the products containing a large amount of digestible iron. According to WHO recommendations all women throughout II and III trimesters of pregnancy and in the first 6 months of a lactation have to accept iron preparations. Treatment by preparations of iron has to be long. Content of hemoglobin increases only by the end of the third week of therapy of iron deficiency anemia. Normalization of indicators of red blood takes place in 5 - 8 weeks of treatment.
the Most preferable is iron administration of drugs inside, but not in the form of injections as in the latter case there can be various side effects more often. Except iron, medicines for treatment of iron deficiency anemia contain various components strengthening iron absorption (cysteine, ascorbic acid, amber acid, folic acid, fructose). For the best shipping preparations of iron should be accepted during food. It is necessary to consider that under the influence of some substances which are contained in food (phosphoric acid, phytin, tannin, calcium salts), and also at simultaneous application of a number of medicines (antibiotics of a tetracycline row, almagel) absorption of iron in an organism decreases. > by
Pregnant it is preferable to p to appoint iron preparations in a combination with ascorbic acid which takes active part in processes of a metabolism of iron in an organism. Content of ascorbic acid has to exceed by 2 - 5 times amount of iron in a preparation. Now for treatment of anemia at pregnant women a number of effective preparations is used. The question of purpose of a concrete preparation, and also of its single dose, frequency rate of application and duration of a course of treatment is solved only the attending physician in an individual order. The doctor also has to control efficiency of the carried-out treatment that is in the best way estimated on the level of a transferrin and ferritin in blood serum, but not on the level of hemoglobin and erythrocytes.
should not stop treatment by iron preparations after normalization of level of hemoglobin and the maintenance of erythrocytes in an organism. Normalization of level of hemoglobin in an organism does not mean restoration of reserves of iron in it. For this purpose WHO experts recommend after 2 - 3 - monthly treatment and elimination of a hematologic picture of anemia not to stop carrying out therapy, and only to reduce twice a dose of a preparation which was used for treatment of iron deficiency anemia. Such course of treatment proceeds within 3 months. Even having restored completely iron reserves in an organism it is expedient to accept small doses of ferriferous preparations within half a year.