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Clinical manifestations of light are a little pale skin and mucous membranes, no obvious symptoms. Severe cases, yellow and white complexion, fatigue, weakness, dizziness, tinnitus, vertigo, activities, palpitation, shortness of breath, easy syncope, accompanied by hypoproteinemia, edema, severe ascites. Symptoms and Signs 1. Recessive deficiency of iron storage decreased, but the red blood cell count, hemoglobin, serum ferritin were within the normal range, clinical manifestations without anemia. 2. Early iron deficiency anemia iron deficiency to continue to develop, leading to erythropoietin minus
Less iron deficiency anemia during pregnancy, but there are still enough of each red blood cell hemoglobin, which "is anemia," can have mild clinical symptoms of anemia, such as skin, mucous membranes slightly pale, fatigue, weakness, hair loss, nail disorders, glossitis and so on. 3. Severe iron deficiency anemia iron deficiency increased bone marrow erythroblastic complete lack of available iron, the apparent bone marrow disorder, a further decline in the number of red blood cells, red blood cells can not get enough of each iron in the synthesis of hemoglobin, small red blood cell count leading to low pigment more, the "small cell hypochromic anemia", showing pale, edema, fatigue, dizziness, tinnitus, palpitation shortness of breath, loss of appetite, abdominal distension, diarrhea and other typical symptoms, or associated with ascites. Cause of a disease. Increased iron


requirements during pregnancy 2. Women body reserves of iron deficiency 3. The food intake of iron is not enough 4. Pregnancy before and after pregnancy diseases such as chronic infection, parasitic disease, kidney disease, pregnancy hypertension, prenatal and postnatal bleeding, can make iron storage, utilization and metabolism disorders, iron, or loss of too much demand, but also affect the generation of red blood cells or anemia treatment. Pathophysiology of pregnancy due to fetal growth and increased blood volume of iron
Iron deficiency anemia during pregnancy requirements increase, especially in the latter half of pregnancy, pregnant women on iron intake or absorption, prone to iron deficiency anemia. Easily lead to severe anemia and maternal perinatal death of children, should be highly valued. The mechanism of iron deficiency during pregnancy: iron is the body's essential elements is to create hemoglobin, the main raw material. Total body iron content of normal adult women, about 2g, mainly in the binding mode of existence, about 65% and the remaining 35% of the iron protein, myoglobin, cytochrome oxidase and over-form, available reserve of iron is about 20%. According to information released by WH0, many women aly exists in non-pregnancy intake of iron deficiency, it can be used during pregnancy only 100mg of iron around the reserve. Diagnosis Diagnosis: iron deficiency anemia criteria mainly based on laboratory examination. If Hb 28pg, mean corpuscular hemoglobin concentration (
Iron deficiency anemia during pregnancy MCHC) 10.7 mol / L (60 g/dl), increased iron binding capacity, transferrin saturation decreased, while no significant decrease of hemoglobin, serum iron is reduced to iron-deficiency anemia significant early performance. 4. Bone marrow iron can stain disappears, bone marrow shows proliferation of red blood cell system, see the erythroblastic cell sorting; later reduced immature red blood cells, indicating decreased bone marrow reserves of iron, hemosiderin and iron particles to reduce or disappear. Of iron deficiency anemia in pregnant women given iron treatment, hematology reflects a increase in the number of reticulocytes, Hb increase rate variability is large, but often less than non-pregnant women, primarily with the hematocrit and red blood cells related to blood volume differences . Laboratory tests: 1. Peripheral 2. Bone marrow 3. Serum iron, total iron binding capacity, iron saturation 4. Ferritin check other laboratory examinations: the condition of patients, clinical manifestations choose to do B-symptoms and signs, electrocardiogram, biochemical and other tests all items. The major clinical differential diagnosis should megaloblastic anemia, aplastic anemia and Mediterranean anemia were identified, based on history and clinical manifestations and blood, bone marrow characteristics, the general differential diagnosis is not difficult. However, several anemia sometimes occur simultaneously. Judge shall conduct a comprehensive analysis in order to develop a reasonable treatment guidelines. Treatment of iron deficiency anemia during pregnancy principle of treatment is to supplement the iron and remove aggravating factors lead to iron deficiency. 1. General treatment to enhance nutrition, encourage pregnant women into the high protein and iron-rich foods. Such as: black fungus, kelp, seaweed, pig (bovine) liver, beans, eggs and food. These foods are not only rich in iron and easily absorbed. Education, maternal change bad eating habits, to avoid partial eclipse, picky eaters. Pregnancy proper rest, and actively prevent premature birth. If specific diseases (such as parasitic diseases, etc.) should also be appropriate treatment for the cause. If gastrointestinal disorders, dyspepsia, symptomatic treatment may be given medication. 2. Drug therapy iron supplementation with satisfactory results, as well as the role of differential diagnosis. (1) oral administration: oral administration generally advocated mainly, its safe and effective, simple, low prices. ferrous sulfate: 0.3g, 3 times / d, if the same time taking 10ml of 1% hydrochloric acid and vitamin C100mg also help iron absorption. Antacids, eggs, dairy products, band other cereals, etc., if the same service can affect iron absorption of iron, so before meals within 1h and 2h after a meal should not be oral ferrous sulfate. If after serving nausea, severe gastrointestinal reactions, but also after meals. However, the absorption rate of iron to some extent. ferrous fumarate: 0.2 ~ 0.4g, 3 times / d, the higher iron content. Irritation of the gastrointestinal tract, but sometimes there are upper abdominal discomfort, diarrhea or constipation. ammonium ferric citrate: 10% ferric citrate 10 ~ 20ml, 3 times / d, for those who have difficulty swallowing pills, but its not easy for the 3 iron absorption, less effective treatment of some, not for severe anemia patients. The oral iron supplement after 5 to 7 days, blood reticulocytes began to increase, reached a peak 7 to 12 days, up to 10% to 15%, followed by Hb and hematocrit gradually increased, showing the clothes iron effective. Hb increased significantly until later, you can gradually reduce the dosage to meet the needs of pregnancy, and the full complement of body iron storage, treatment should be maintained to 3 months postpartum. If the rules 3 weeks after treatment, blood still no significant improvement, you should consider whether the iron deficiency anemia. (2) injection drug use: injection with iron is used in late pregnancy with severe iron deficiency anemia or patients because of severe gastrointestinal reaction to those who can not accept oral administration. Absorbed quickly after use. The disadvantage is that injection of local pain. About 5% of patients may have a negative reaction or systemic toxicity, such as headache, dizziness, can occur even fatal allergic reactions. Commonly used agents are: iron dextran: iron per milliliter 50mg, the first intramuscular injection of 50mg, if no response can be increased to 100mg, 1 intramuscular injection every day or every other day, 15 to 20 days for a course of treatment, the general 300mg per injection can improve the Hb10g / L. sorbitol iron: iron per milliliter 50mg, every 50 ~ 100mg deep intramuscular injection, local reactions smaller but heavier body reaction. 3. Transfusion therapy most of the iron deficiency anemia after iron supplementation in pregnant women by clinical symptoms and improve the blood very quickly, without blood transfusion for severe anemia in pregnant women, pregnancy, childbirth facing term treatment, they should improve the Hb. Need a blood transfusion, it is desirable to take a small amount, many times, a slow input of fresh blood or red blood cell hematocrit 150ml (1500ml blood from the extraction), in order to avoid excessive increase in blood volume increased burden on the heart. According to reports: often accompanied by severe anemia in pregnant women determined to dysfunction, blood transfusion can precipitate or aggravate heart failure, pulmonary edema, the blood hematocrit red blood cells instead of the new input, can greatly reduce the risk of blood transfusion and symptoms quickly improved. China reported that application of recombinant erythropoietin (Ning Hongxin), adding iron can make pregnancy and postpartum hemoglobin was significantly increased in patients with anemia, the symptoms improved rapidly, and thereby avoid or reduce the number of patients with moderate to severe anemia, blood transfusion requirements. 4. Intrapartum and postnatal treatment of labor after: to encourage mothers to eat, to ensure adequate intake and avoid excessive or rapid labor productivity, strengthen the fetal heart rate monitoring, continuous low flow oxygen. Moderate or severe anemia, blood should be equipped with new spare, and the opening of the vein. Cervix, after all, can reduce the 2 midwifery birth process, but should try to avoid accidents, birth trauma. Postpartum actively prevent postpartum hemorrhage, fetal shoulders after delivery intravenous oxytocin immediately 10 ~ 20U, if no contraindications, the placenta after delivery can be intramuscular or intravenous injection of ergometrine 0.2mg, while using oxytocin 20U in 5% glucose intravenously, for at least 2h. After the baby is delivered, carefully check and serious perineal vaginal wound closure and strict aseptic technique. Post-partum antibiotics to prevent infection in the birth canal. Indications for cesarean delivery if required, the surgery should minimize bleeding, careful to take a good amount of fluid or blood transfusion and speed. The principle of a drug. Treatment of iron deficiency anemia should be based on the degree of anemia may be, generally mild to moderate blood medication to "A" main; can also use the "C" in the 1 ¯ 42. Severe or very severe anemia can be transmission of whole blood or red blood cell suspension, or may choose "C" in the other drugs; 3. for those with chronic blood loss should actively bleeding, and improve nutrition. Prognosis Prevention Prognosis: generally good treatment, after iron
Correctable maternal anemia agent. Prevention: 1. Aggressive treatment of blood loss before pregnancy through the multi-moon and other diseases, to increase iron reserves. 2. Nutrition during pregnancy to strengthen and encourage consumption of iron-rich foods such as liver, chicken, beans and so on. 3. 4 months of pregnancy from the regular iron supplements, daily oral ferrous sulfate 0.3g, while vitamin C, is conducive to the absorption of iron. Given amino acid chelated calcium capsules (music power), the daily one. 4. In the prenatal examination, routine blood test every pregnant woman must be checked, especially in late pregnancy Epidemiology of anemia in pregnancy accounted for about 95%. The disease throughout the world, but regional differences, and economic development and social status of women is closely related, often with poverty and backwardness, accompanied by malnutrition. According to WHO survey: the incidence of iron deficiency anemia European women was 4% to 7%, 6%, Americas 10%, 40% in developing countries 58%. The data also show that domestic and foreign, the use of diagnostic
Iron deficiency anemia during pregnancy off different standards, the incidence of anemia during pregnancy are very different, such as the WHO standards, significantly higher incidence in the world, there are about 700 million people are iron deficient, the total world population of 1 / 8 . Month by Wang et al (1984) study pointed out: If the hemoglobin (Hb) 10.4ng/ml both as the standard, the rate was 36.6%. In addition, the pregnancy rate in different periods of their occurrence is very different, generally before 20 weeks of pregnancy the incidence of iron deficiency anemia is not high; from the second trimester, was significantly increased, and non-pregnant women were significantly different. The survey data also pointed out: If you do not iron supplements during pregnancy, most pregnant women, the reserve will be depleted of iron, the Hb level decreased until 6 months after delivery serum ferritin is also difficult to restore to normal levels during the non-pregnant . Health Tips 1, eating high-calorie, high vitamin, protein, iron-rich
Sibu foods such as fish, lean meat, animal liver, spinach. 2, to maintain oral hygiene, fasting, mouthwash after meals, before going to bed, early morning brush your teeth; oral bleeding, you should use a soft bristle toothbrush. 3, to keep warm and avoid cold. 4, providing a quiet environment to rest, ensuring adequate sleep. 5. Enhance nutrition, encourage pregnant women into the high protein and iron-rich foods. Such as: black fungus, kelp, seaweed, pig (bovine) liver, beans, eggs and food. These foods are not only rich in iron and easily absorbed. Education, maternal change bad eating habits, to avoid partial eclipse, picky eaters. 6. Pregnancy proper rest, and actively prevent premature birth. If specific diseases (such as parasitic diseases, etc.) should also be appropriate treatment for the cause. If gastrointestinal disorders, dyspepsia, symptomatic treatment may be given medication. Routine iron supplementation for all pregnant women, even though the normal diet and nutritional intake of pregnant women is no exception. Experts suggest iron deficiency anemia is more common, particularly pregnant women, mainly due to insufficient iron intake, physical requirements increase or chronic blood loss, late pregnancy, 25% of pregnant women due to insufficient intake of iron anemia, if diagnosed ( excluded erythroblastic anemia, aplastic anemia and hemoglobin disease) in a timely manner given iron supplements at the same time to stop the bleeding, a positive effect,
Sibu for mild to moderate anemia, generally given orally or intramuscularly iron can be cured. For severe or very severe anemia, or nearly pre-production period, and need surgery, blood transfusion or red blood cell suspension can quickly correct anemia, but should pay attention, this time pregnant women at high cardiac output state, myocardial oxygen often, too much blood too fast can cause congestive heart failure, so a small amount of blood transfusion should be repeated. Complications 1. Anemia can be severe with severe pregnancy edema, shortness of breath, heartbeat after the event, and even heart disease and anemia can occur with congestive heart failure. 2. Strict aseptic production process, and post to the broad-spectrum antibiotics to prevent infection. 3. Labor reserve of blood, at the discretion of vitamin K1, Ka Bake network, vitamin C and so on. 4. Intensive care delivery process, to prevent prolonged labor, vaginal delivery to shorten the second stage of labor. 5. When the baby after delivery before the shoulder, intramuscular or intravenous uterotonics (10U oxytocin or ergometrine 0.2mg). Or when the fetus after delivery vaginal or rectal suppository methyl forefront Fonseca 1mg, to prevent postpartum hemorrhage. Bleeding should prompt blood transfusion. 6 . pregnancy induced hypertension, premature birth, fetal growth restriction and stillbirth. Severe iron deficiency anemia in pregnant women may cause fetal iron supply to the potential impact, and because of the high incidence of premature delivery and pregnancy complications, perinatal mortality was higher in children.


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