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Chapter 26. Extragenital diseases with pregnancy
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CHAPTER 26. EXTRAGENITAL DISEASES WITH PREGNANCY
The course of gestation is usually complicated in patients with extragenital diseases. At the same time, the course of chronic extragenital disease is complicated because of gestational process. Usually it leads to a lot of maternal and perinatal complications, even to death. So, patients with extragenital diseases usually need special care during pregnancy.
ANEMIA IN PREGNANCY
Anemia is a disease from the group of blood disorders affecting red blood cells, which carry oxygen to the body's tissues. It is a condition of having a lower-than-normal number of red blood cells (RBC) or quantity of hemoglobin (Hb). Anemia diminishes the capacity of the blood to carry oxygen.
Several types of anemia are distinguished in general practice.
Iron-deficiency anemia: Iron is necessary for the body to make red blood cells. Low iron intake and loss of blood due to menstruation are the most common causes of iron-deficiency anemia. It may also be caused by blood loss from the GI tract because of ulcers or cancer.
Pernicious anemia (B12 deficiency): A condition that prevents the body from absorbing enough B12 in the diet. This can be caused by a weakened stomach lining or an autoimmune condition. Besides anemia, nerve damage (neuropathy) can eventually result.
Folate-deficiency anemia: lack of folic acid in the blood. Folic acid is the synthetic version of the vitamin folate, also called B9. Folic acid (folate) is involved in the production of red blood cells. Lack of folate is responsible for the deficiency of red blood cells, thus anemia develops. Low levels of folic acid can cause megaloblastic anemia. With this condition, red blood cells are larger than normal. There are fewer of these cells. They are also oval-shaped, not round. Sometimes these red blood cells don’t live as long as normal red blood cells.
Aplastic anemia: In people with aplastic anemia, the bone marrow does not produce enough blood cells, including red blood cells. A viral infection, drug side effect, or an autoimmune condition can cause aplastic anemia.
Autoimmune hemolytic anemia: In people with this condition, an overactive immune system destroys the body's own red blood cells, causing anemia.
Anemia of chronic disease: People with chronic kidney disease or other chronic diseases tend to develop anemia.
Sickle cell anemia: A genetic condition that affects mostly people whose families have come from Africa, South or Central America, the Caribbean islands, India, Saudi Arabia, and Mediterranean countries that include Turkey, Greece, and Italy. The diseases characterized with increased breakdownof RBCs ( hemolytic). In sickle cell anemia, the red blood cells are sticky and stiff, they can block blood flow. Severe pain and organ damage can occur.
During pregnancy, the most common types of anemia: iron deficiency anemia, folate-deficiency anemia, Vitamin B12 deficiency anemia.
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Iron Deficiency Anemia in Pregnancy
Definition of anemia: World Health Organisation (WHO) define aaemia as haemoglobin (Hb) level< 110 g/L in pregnancy and < 100 g/L postpartum
Incidence. The incidence of Iron deficiency anemia (IDA) in pregnancy varies greatly. In the developed countries the incidence makes up 10-20%. In the developing countries it ranges from 40 to 80%. In general, Iron deficiency is the most common anemia in pregnancy. About 95% of anemia cases during pregnancy are due to iron deficiency.
Etiology and Pathogenesis of Iron Deficiency in Pregnancy
During pregnancy there is a disproportionate increase in plasma volume, erythrocyte number and hemoglobin mass. Whereas the plasma volume increases by about 40%, the number of erythrocytes and hemoglobin mass increases by about 20% each. Thus, there is an apparent fall in hemoglobin concentration and hematocrit value.
There is a marked extra demand of iron during pregnancy, especially in the second half. The fall in hemoglobin concentration during pregnancy is due to the combined effect of hemodilution and negative iron balance. The woman who has got sufficient iron reserve and is on balanced diet is unlikely to develop anemia during pregnancy in spite of increased demand for iron. But if the iron reserve is inadequate or absent, the factors which lead to the development of anemia during pregnancy are:
· increased demands for iron;
· diminished intake of iron (apart from socioeconomic factors, the inadequate dietetic habits, loss of appetite and vomiting in pregnancy are responsible factors);
· disturbed metabolism;
· pre-pregnant health status;
· abnormal demand: multiple pregnancy increases the iron demand twofold. Women with rapidly recurrent pregnancy, within 2 years following the last delivery, need more iron to replenish deficient iron reserve.
Iron deficiency occurs when the level of stored iron becomes depleted. Iron deficiency anemia occurs when iron levels are sufficiently depleted to produce anemia. In Iron deficiency anemia there is shortage of iron stores (low ferritin), reduced transport and functional iron (low transferrin), limiting red cell production e. g. reduced Haemoglobin (Hb).
The group of patients with a higher risk of anemia in pregnancy includes:
· women with extragenital diseases (rheumatism, cardiac diseases, chronic pyelonephritis, gastroenteritis, diabetes, chronic tonsillitis, liver diseases, etc);
· multiparae;
· women in which this pregnancy occurred in the period of lactation;
· women, in which the previous pregnancy was complicated with preeclampsia-eclampsia syndrome, hemorrhages, anemia;
· women, in which this pregnancy is complicated with hemorrhages, threatened abortions, preeclampsia-eclampsia syndrome, viral infections;
· women with mulnutrition
Risk factors for iron deficiency or IDA in pregnant women also include an iron-deficient diet, gastrointestinal issues affecting absorption, or a short pregnancy interval.
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