Postpartum Anemia Research Articles

Socio-Demogrphic Profile and Complications of Patients with Retained Placenta in a Tertiary Centre, South-South Nigeria

Retained placenta is a life threatening emergency and a major cause of primary postpartum haemorrhage and maternal morbidity in the developing world. Objectives: To determine the socio-demographic characteristics and complications in patients presenting with retained placenta in this centre. Materials and Method: This was a retrospective study of all cases of retained placenta managed at the UCTH from January 1st 2008 to December 31st 2012. The case records of these patients were retrieved and analysed using Epi info 3.3.2. Results: There were 138 patients with retained placenta during the period, giving an incidence of 1.02%. The mean age was 27.7 ± 4.6 years with a range of 17 - 41 years. Majority of the cases of retained placenta occurred in the age group of 26 - 30 years (37%); para 4 (36.1%); traders (48.7%) and unbooked (68.1%). Most patients delivered outside the hospital by unskilled birth attendants at churches, traditional birth attendants and patient’s home (69.0%). Eleven (9.2%) patients had previous caesarean sections while 7 (5.9%) had placenta retention in the past. The complications observed were mostly primary postpartum haemorrhage 67 (56.3%) and anaemia 79 (66.4). Unbooked patients significantly had more primary postpartum haemorrhage (P-value = 0.0325) and anaemia (P-value = 0.0000) than the booked patients. Nineteen (16.0%) patients presented in shock out of which 1 died due to severe haemorrhagic shock, giving a case fatality rate of 0.8%. Conclusion: Poorly managed labour and delivery is the major cause of retained placenta. Therefore, supervised hospital delivery is paramount to reduce the observed complications.

Rates and determinants of peripartum and puerperal anemia in Enugu, Nigeria.

Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and mortality during and after delivery. To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal anemia among a cohort of women with both normal and cesarean deliveries, following uncomplicated term singleton pregnancies in Enugu, Nigeria. A prospective longitudinal study involving women with uncomplicated singleton pregnancies who were recruited at term at two tertiary maternity centers and were followed up with the determination of hemoglobin and ferritin concentrations till 6 weeks after delivery. Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA). A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks postpartum were 11.1 ± 0.9 g/dL, 10.5 ± 0.8 g/dL, and 11.2 ± 1.0 g/dL, respectively. The proportions of women with anemia at term, 48 h, and at 6 weeks postpartum were 46.0%, 72.8%, and 47.5%, respectively. Forty-eight hours postdelivery, 17.3% had anemia with low serum ferritin compared to 7.4% by 6 weeks postdelivery. Anemia at term (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.01, 4.05), anemia at 48 h postdelivery (aOR 6.17; 95% CI 3.30, 11.6), and low ferritin at 48 h postdelivery (aOR 3.11; 95% CI 1.51, 5.09) all increased the likelihood of anemia at 6-week postpartum. A high proportion of low-risk pregnant women in the study centers could go through delivery with undetected anemia and this would predispose to high rates of postpartum anemia. Screening of low-risk women at term and in the immediate postdelivery periods may be necessary to improve detection of such cases.

The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal

Background/Objectives:Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal.Subjects/Methods:In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein.Results:The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations.Conclusions:Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.

Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care.

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. Obstetric bleeding can be catastrophic and management is challenging, involving a coordinated multidisciplinary approach, which may include blood products. In settings where blood transfusion is not an option, either because of patient refusal (most commonly in Jehovah Witnesses) or because of unavailability of blood, management becomes even more challenging. Observational studies have demonstrated an association between refusal of blood products in major obstetric haemorrhage and increased morbidity and mortality. This review draws upon evidence in the literature, physiological principles and expert opinion for strategies and guidance to optimise the outcomes of pregnant women in whom blood transfusion is either refused or impossible. The importance of a multidisciplinary antenatal and perinatal management plan, including optimisation of haemoglobin and iron stores pre-delivery, blood loss minimisation, early haemorrhage control and postpartum anaemia treatment, is discussed.

Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study.

To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. A total of 30198 women delivering between 2002 and 2008. Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n=558), women with a psychiatric illness but no antidepressant use (n=1292), and women with neither antenatal exposures (n=28348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. The primary outcome was PPH, defined as a recorded blood loss of ≥500mL for vaginal deliveries and ≥1000mL for caesarean sections. Secondary outcomes included severe PPH (≥1000mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR1.53; 95% confidence interval, 95%CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR1.04; 95%CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR1.84; 95%CI 1.39-2.44), as well as postpartum anaemia (aRR1.80; 95%CI1.46-2.22). Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH. Late gestation antidepressant exposure is associated with a significantly increased risk of postpartum haemorrhage.

El parto en eclampticas

Se realizó el estudio de 159 casos de eclampsia que se presentaron en el Hospital Base Cayetano Heredia de Lima, en el lapso de diez años (1976-1985), siendo la incidencia de 4.4% o por partos atendidos. En cuanto a la edad, 37% correspondieron al grupo de 15 a 19 años siendo las primigestas las que más lo presentaron (69%). Del total de 149 nacidos de partos de madres eclámpticas, 25 fallecieron (16.8%). La complicación más frecuente en el puerperio fue la anemia. Se registró 4 muertes maternas.

Anemia en obstetricia y cirugía ginecológica

Iron deficiency is more common in women due to uterine bleeding, which affects them throughout their fertile life. Additionally, iron needs increase physiologically during pregnancy and breastfeeding. Pregnant women therefore constitute one of the risk groups for iron deficiency. During the postpartum period, iron deficiency is the most common cause of anemia. Longer hospital stays and greater susceptibility to infections are potential consequences of postpartum anemia.

The Use of Parenteral Iron Therapy for the Treatment of Postpartum Anemia.

Rates of postpartum hemorrhage have been increasing in Canada over the last 10 years, with postpartum iron deficiency anemia as the most common consequence. Postpartum anemia is treated with oral iron supplementation and/or blood transfusion. Recent studies have evaluated the use of parenteral iron as a better tolerated treatment modality. Compared with oral iron supplements, parenteral iron is associated with a more rapid rise in serum ferritin and hemoglobin and improved maternal fatigue scores in the postpartum period. It may also decrease rates of blood transfusion. Parenteral iron may be considered in select clinical situations for the treatment of postpartum anemia.

Post-partum anemia and factors that work against alleviation of the anemia.

This study aimed to clarify conditions of women experiencing post-partum anemia and identify factors that work against the alleviation of anemia. This was a retrospective longitudinal study, involving 246 women giving birth at five participating institutions, diagnosed with anemia on day 3 post-partum, and given a blood sample at the medical examination 1 month after the birth. With answers about alleviation of anemia during the 1 month post-partum period as an objective variable, and explanatory variables, multiple logistic regression analysis was performed. The explanatory variables included demographic data of the participants, information about anemia, following the nutrition instruction advice for anemia alleviation, family structure and others assisting the participants, and self-management skills (measured by the Self-Management Skill [SMS] scale). The present authors collected 211 valid responses; the average age was 32.6 years. The mean hemoglobin values on the 3rd and 30th days post-partum were 9.6 and 12.0 g/dL, respectively. One fifth of the participants (21.3%) showed no anemia alleviation. The mean value on the SMS scale was 28.35, and the anemia alleviated group (30.78) was significantly higher than the non-alleviated group (19.38). Results of the multiple logistic regression analysis showed a strong relationship between anemia risk and self-management skills. The absence of anemia alleviation increased 2.51 times as the total score of the SMS decreased 1 point. There is an urgent need to develop an intervention program to alleviate post-partum anemia focusing on the low score items because self-management skills strongly affect alleviation improvement.

English

To compare effectiveness of intravenous iron-sucrose versus oral ferrous sulphate in pospartum anemia in rural area. METHODS AND MATERIAL: In this study, 120 women with postpartum anemia with hemoglobin (Hb) less than 10 g/dl within 48 h postpartum were randomised into two groups. Group I consisted of 60 women who received 300-600 mg of intravenous iron-sucrose every alternate day for 3 days. Group II consisted of 60 women who were given 300 mg ferrous sulphate orally daily for a month. Data collected after 1 month for Hb estimation and other postpartum parameters are assessed. RESULTS: The mean Hb was significantly increased in the intravenous iron sucrose group in 4th week of treatment but there was minimal change observed in mean Hb in patients treated with oral ferrous sulphate. Women treated with intravenous iron sucrose has shown significantly higher Hb as compared to those treated with oral iron. CONCLUSIONS: Overall intravenous iron sucrose appears to be an effective and safe mode of treatment in postpartum patients with no serious side effects than oral iron therapy.

Ferric carboxymaltose: A revolution in the treatment of postpartum anemia in Indian women.

Objectives:The objective of the present study is to compare the safety and efficacy of ferric carboxymaltose (FCM), intravenous (IV) iron sucrose and oral iron in the treatment of post = partum anemia (PPA).Materials and Methods:A total of 366 women admitted to SCB Medical College, Cuttack between September 2010 and August 2012 suffering from PPA hemoglobin (Hb) <10 g/dL were randomly assigned to receive either oral iron or IV FCM or iron sucrose. FCM, IV iron sucrose, and oral iron were given as per the protocol. Changes in hemoglobin (Hb) and serum ferritin levels at 2 and 6 weeks after treatment were measured and analyzed using ANOVA. Adverse effects to drug administration were also recorded.Results:A statistically significant increase in Hb and serum ferritin level were observed in all three groups, but the increase in FCM group was significantly higher (P < 0.0001) than conventional iron sucrose and oral iron group. The mean increase in Hb after 2 weeks was 0.8, 2.4, and 3.2 g/dL and 2.1, 3.4, and 4.4 g/dL at 6 weeks in oral iron, iron sucrose and FCM groups, respectively. The mean increase in serum ferritin levels after 2 weeks was 2.5, 193.1, and 307.1 and 14.2, 64, and 106.7 ng/mL after 6 weeks in oral iron, iron sucrose and FCM groups, respectively. Adverse drug reactions were significantly less (P < 0.001) in FCM group when compared with other two groups.Conclusion:Ferric carboxymaltose elevates Hb level and restores iron stores faster than IV iron sucrose and oral iron, without any severe adverse reactions. There was better overall satisfaction reported by the patients who received FCM treatment.

Clinical Criteria for Transitioning from Oral to IV Iron Replacement Therapy in Patients with Iron Deficiency Anemia

▪Introduction: Oral iron supplementation is an effective means of iron replacement. Nevertheless, there is a frequent need to transition patients with iron deficiency anemia (IDA) from oral to intravenous (IV) iron therapy for inadequate response. No definitive guidance on the optimal timing for this change in therapy exists. Serum hepcidin may be a marker in predicting response to oral iron therapy, but currently, hepcidin assays are not commercially available. We evaluated the ability of various early response characteristics to accurately predict for an overall hemoglobin (Hb) response to oral iron. Our objective was to identify an early predictor of overall Hb response in patients on oral iron treatment as a guide to the decision to switch from oral to IV iron in patients unlikely to benefit from continued oral iron.Methods: Proprietary datasets from 6 published randomized studies in which oral iron (325 mg of ferrous sulfate containing 65 mg of elemental iron, t.i.d.[4 studies], 304.3 mg capsules containing 100 mg bivalent iron b.i.d [1 study] and as prescribed by the investigator [1 study]) was used as a comparator to ferric carboxymaltose were analyzed. Five studies were pooled into one primary analysis dataset and one study was analyzed separately due to differences in study design that precluded pooling. Patients were grouped by the underlying etiology of their IDA (postpartum, heavy uterine bleeding, gastrointestinal, and others) and stratified by those who had ≥ 1 g/dL Hb change after 14 days of oral iron therapy (responders) and those who did not (non-responders). Further analyses evaluated Hb response at various time points based on initial 14 day Hb response (≥ 1 g/dL change vs < 1 g/dL). We systemically evaluated changes in hemoglobin, absolute reticulocyte count, % reticulocyte count, ferritin, and transferrin saturation at specific time points to determine their ability to predict overall Hb response.Results: A total of 738 patients who were randomized to oral iron were included in the pooled study analysis. In the separate study, a total of 253 patients, all non-responders, were included. The mean baseline values for the 6 studies were Hb 9.9 g/dL, ferritin 19.9 ng/mL, and TSAT 16.9%. The vast majority of patients (96%) were females with a mean age of 36 years. In the pooled analysis, by day 14 of oral iron treatment, 27.2% (201/738) of patients had a Hb increase of < 1 g/dL (non-responders). Of these 201 patients, less than half (46.8%, 94/201) achieved an increase in Hb ≥ 1 g/dL from baseline after 2 additional weeks of oral iron (by day 28) and only 63.2% (127/201) had an increase in Hb ≥ 1g/dL from baseline after 6 to 8 weeks of oral iron (42 to 56 days). Furthermore, only 27.4% (55/201) and 5.5% (11/201) had an increase in Hb of 2 or 3 g/dL respectively at the Day 42 or 56 measurement. In comparison, responders (those who had a Hb increase ≥ 1 g/dL by 14 days of treatment) sustained a robust Hb response with continued dosing of oral iron. After 4 weeks of oral iron (28 days), 84.9% of the responders had a ≥ 2 g/dL increase in Hb from baseline. After 6 to 8 weeks of oral iron (42 or 56 days), 92.9% of the patients had ≥ 2 g/dL Hb increase from baseline, significantly different from non-responders (p < 0.0001). Patients with etiology of postpartum anemia had the most robust Hb response to oral iron. Results observed in the sixth study were similar to the pooled analysis. Only 10.2% (17/167) of non-responders who continued oral iron after day 14 achieved a Hb ≥ 2g/dL by Day 35, whereas 38.8% (57/147) who were switched to IV ferric carboxymaltose achieved a Hb > 2/dL by Day 35 (p =0.0001). Hb response after 14 days of oral iron was a strong predictor of overall response (sensitivity = 90.1%, specificity = 79.3%, positive predictive value = 92.9%, negative predictive value= 72.7%), surpassing other parameters evaluated in this study.Conclusion: In the absence of significant continuous blood loss, Hb measurements taken 14 days after initiation of oral iron therapy can reliably predict overall response in Hb to oral iron therapy. Accordingly, day 14 Hb may be a useful tool for clinicians in determining when to switch patients from oral to IV iron. DisclosuresKoch:Luitpold Pharmaceuticals: Employment.

Selective serotonin reuptake inhibitor use during pregnancy increases the risk of postpartum hemorrhage and anemia: a hospital‐based cohort study

Selective serotonin reuptake inhibitors (SSRIs) are known to increase the risk of gastrointestinal bleeding. Study the risk of bleeding-related complications in relation to SSRI in pregnancy. This was a hospital-based cohort study. All women who gave birth at Karolinska University Hospital in Stockholm over a 5-year period (2007 to 2011) were included in the study. Those women who the electronic maternal health record indicated were using SSRI (n = 500) were considered exposed, and all other women formed a control population (n = 39,594). The main outcome measures were blood loss, postpartum hemorrhage (PPH), PP anemia and length of hospitalization. The absolute risk of PPH and PP anemia for the 1.2% exposed to SSRI were 18.0% and 12.8%, respectively. Women with a vaginal non-surgical delivery who reported use of SSRI during pregnancy had approximately a 2-fold increased risk of both PPH (OR, 2.6; 95% CI, 2.0-3.5) and PP anemia (OR, 2.1; 95% CI, 1.5-2.9), as compared with controls. Blood loss and length of hospitalization were significantly higher among women using SSRI than non-users (arithmetic mean 484 mL vs. 398 mL, 3.8 days vs. 2.4 days, respectively). The use of SSRI during pregnancy increases blood loss and doubles the risk of PPH and PP anemia in a setting where SSRI had not been considered a risk factor for increased blood loss. Because PPH is a leading cause of maternal mortality and morbidity, the awareness of bleeding-related complications is important, both in relation to pregnancy and to surgery in general.

PO-0373 Lead, Mercury, Cadmium Levels In Breast Milk And Infant Hair In The Late Period Of Lactation From Ankara, Turkey

Aim Lead (Pb), mercury (Hg), cadmium (Cd) are found widely in environment and stay in nature for a long time. These toxic chemicals have some hazardous effects on child health. The purpose of this study are to determine the levels of heavy metals (Pb, Hg, Cd) in breast milk and infant hair, related environmental factors and the effect on infant growth and development at the postpartum 8th month. Method As a part of the cohort study at Hacettepe University Department of Social Paediatrics, 74 breast milk samples and 46 infant hair samples were taken at the postpartum 8th month. Mothers’ environmental exposure were evaluated by a semistructured questionnaire. Results Pb, Hg, Cd were detected in breast milk samples of 91%, 87%, 99%, respectively. Breast milk Hg levels were associated with maternal vitamin use within the first 2 months after delivery, breast milk Cd levels were higher in cases with expanded family, living in older house and in urban with air pollution during childhood. Higher infantile hair Cd levels were higher in cases with expanded family, living older house, maternal history of anaemia and postpartum anaemia. In girls z scores of birth weight, height for age at the 8 th month were inversely correlated with infant hair Pb levels. In boys, z scores of body mass index at the 8th month were inversely correlated with infant hair Cd levels. The levels of breast milk Hg levels were higher in infants with Denver II suspicious/abnormal. Conclusion It is suggested that presence of Pb, Hg, Cd in breast milk and infant hair have been affected infants of developmental and growth parameters. Preventive measures must be taken to reduce environmental toxic metals pollution and efforts should be made for the management of anaemia in females in all age groups.

Health status and fatigue of postpartum anemic women: a prospective cohort study

ObjectiveThe incidence of postpartum anemia is high. Current therapy consists of iron supplementation or blood transfusions, based on the assumption that these treatments improve health status (HS) and reduce fatigue. The aim of this study was to compare HS and fatigue in postpartum women with and without anemia. Study designThis prospective cohort study was performed in The Netherlands between April 2008 and August 2010 and involved 112 anemic (hemoglobin [Hb]<10.5g/dL) and 108 non-anemic (Hb≥10.5g/dL) women. The anemic women received oral iron supplementation. Within 48h and 5 weeks after delivery, HS was measured using the 36 item Short-Form Health Survey (SF-36) and fatigue was measured using the Checklist Individual Strength (CIS). ANOVA for repeated measures was used to compare HS and fatigue scores among groups and across time. ResultsAfter adjustment for confounding variables, there were no differences in any of the HS and fatigue scores. HS and fatigue seem to be more influenced by a complicated delivery than by anemia. HS and fatigue scores significantly improved over time in all women. ConclusionHS and fatigue were not different among women with and without postpartum anemia.

Comparison of Perinatal Data of Immigrant Women of Turkish Origin and German Women - Results of a Prospective Study in Berlin.

Aims: The aim of the study was to compare obstetrical process indicators and outcomes for German women with women of Turkish origin residing in Germany. Do women of Turkish origin attend antenatal examinations as frequently as non-immigrant women? Are high-risk pregnancies and anemia more common among immigrant women? Are the rates for epidural analgesia (PDA) and combined spinal-epidural analgesia (CSE) during delivery the same for immigrant women compared to German women? Are there identifiable differences in the mode of delivery and in perinatal outcomes? Patient Population/Methods: Data were obtained from 3 maternity clinics in Berlin for the period 2011 to 2012. The questionnaires covered socio-demographic factors and information on prenatal care as well as immigration/acculturation. The data obtained from these questionnaires was supplemented by information obtained from the official maternal record of prenatal and natal care (Mutterpass) and perinatal data recorded by the clinic. Results: The response rate was 89.6 %; the data of 1277 women of Turkish origin who had immigrated to Germany or whose family had immigrated and of 2991 non-immigrant women in Germany were included in the study. Regression analysis showed no statistically significant difference in the number of antenatal examinations between immigrant and non-immigrant women. Women of Turkish origin born in Germany had a significantly higher risk of postpartum anemia. PDA/CSE rate, arterial umbilical cord pH and 5-minute Apgar scores did not differ. The incidence of cesarean sections (elective and secondary) was significantly lower in the population of immigrant women of Turkish origin. Conclusion: Outcomes for most perinatal parameters were comparable for immigrant and non-immigrant women. These results indicate that the achieved standards of antenatal care and medical care during pregnancy are similar for Turkish immigrant women compared to non-immigrant women in maternity clinics in Berlin. The higher rates of anemia among immigrant women should be targeted by preventive measures.

Use of Prophylactic Misoprostol in Reduction of Blood Loss at Vaginal Delivery

INTRODUCTION: The objective of this study was to assess the effect of prophylactic adjunctive rectal administration of misoprostol on reduction of blood loss at vaginal delivery and incidence of postpartum anemia. METHODS: Open-label, randomized prospective trial of 143 term singleton pregnancies, 2011–2013. Exclusion criteria were grand multiparity, multiple gestations, intrauterine fetal demise, preeclampsia, polyhydramnios, third- or fourth-degree laceration, and cesarean delivery. Group A included 73 patients who received 600 micrograms misoprostol per rectum postpartum in addition to conventional management. Group B included 70 patients who received conventional management with oxytocin administration. Primary outcome was reduction in hemoglobin and hematocrit values from admission to 24 hours after delivery. Baseline demographics, clinical characteristics, and results were analyzed using SPSS 20.0 with one-way analysis of variance and χ2 tests. P<.05 was considered significant. RESULTS: The two groups did not differ with respect to age, parity, ethnicity, degree and type of lacerations, episiotomy, epidural analgesia, presence of postpartum hemorrhage, incidence of operative vaginal delivery, mean blood loss at delivery, average birth weight, body mass index, or mean duration of stages 1, 2, or 3 of labor. More patients in group A received augmentation with oxytocin (P=.039), and five patients developed postpartum endometritis compared with none in group B (P=.032). The mean difference in the reduction of hemoglobin concentration (mg/dL) (A=1.08, B=1.20; P=.484) and hematocrit (%) (A=2.91, B=3.31; P=.491) was not significant. In the presence of lacerations, reduction of hemoglobin was significant in group B (1.43 mg/dL, P=.034) compared with group A (1.18 mg/dL, P=.891). CONCLUSION: Adjunctive administration of prophylactic rectal 600 micrograms misoprostol reduces postpartum anemia in patients with perineal lacerations.

A randomized controlled trial examining the addition of folic acid to iron supplementation in the treatment of postpartum anemia

ObjectiveTo evaluate the efficacy of adding folic acid to oral iron supplementation in postpartum women with anemia. MethodsA randomized controlled trial was conducted in the Netherlands between April 8, 2008, and August 31, 2010. A total of 112 postpartum women with anemia (hemoglobin <10.5g/dL) were randomly allocated to receive 600mg/day ferrous fumarate plus 1mg/day folic acid (FFFA group) or 600/day ferrous fumarate alone (FF group) for 4weeks. Primary outcome measures were hemoglobin and health status. Secondary outcome measures were fatigue, compliance, and adverse reactions. ResultsNo between-group differences were observed in hemoglobin and health status after treatment, and no differences were found in fatigue scores. Approximately 75% of all women reported having at least one symptom resulting from ferrous fumarate use. Constipation caused by ferrous fumarate was significantly associated with non-compliance (P=0.014). ConclusionThe addition of folic acid to iron supplementation is not beneficial in women with postpartum anemia, as it has no effect on hematologic or health status parameters. Clinical Trial Registration: CCMO website NL21797.028.08 and Netherlands Trial Register NTR2232.

Determinants of postpartum anemia among women from a rural population in southern India.

BackgroundEven though the problem of anemia during pregnancy has been adequately emphasized, very little attention has been paid to postpartum anemia. The objective of the current study was to estimate the mean change in maternal hemoglobin from 36 weeks’ gestation to 6 weeks postpartum and to identify the factors associated with anemia during the postpartum period among women in a rural development block in Tamil Nadu, India.MethodsNinety-three pregnant women were interviewed using a structured questionnaire at 36 weeks’ gestation and then at 2 and 6 weeks postpartum. Blood samples were collected from the participants at 36 weeks’ gestation and at 6 weeks postpartum. Paired t-tests assessing the difference in mean hemoglobin prepartum and postpartum, univariate analysis, and multiple logistic regression to identify factors associated with postpartum anemia were done using Statistical Package for the Social Sciences version 12 for Microsoft Windows software.ResultsThe proportion of study subjects who were anemic (hemoglobin <11 g/dL) at 36 weeks’ gestation was 26.8% and at 6 weeks postpartum was 47.3% (hemoglobin <12 g/dL). The mean hemoglobin at 36–38 weeks’ gestation was 11.70±1.43 g/dL and at 6 weeks postpartum was 12.10±1.27 g/dL. Anemia at 36 weeks’ gestation (odds ratio [OR] 10.47, 95% confidence interval [CI] 2.37–42.34), heavy blood loss perceived by the mother during delivery (OR 12.91, 95% CI 2.01–61.25), younger maternal age (<21 years, OR 2.45, 95% CI 1.28–23.86), and inadequate iron supplementation during the postpartum period (OR 3.53, 95% CI 1.18–11.37) were identified as significant factors associated with anemia at 6 weeks postpartum.ConclusionAnemia during the third trimester of pregnancy, heavy bleeding perceived by the mother during delivery, younger maternal age, and inadequate iron supplementation during the postpartum period were associated with postpartum anemia.

English

BACKGROUND: Postpartum anemia can develop after delivery because of unforeseen medical problems during and after delivery which could complicate a mother's ability to properly care for her newborn child. The current treatment for postpartum anemia is oral iron supplementation but this treatment has been associated with gastrointestinal side effects. Alternative treatment includes blood transfusions and intravenous iron therapy. Since blood transfusions are very costly, intravenous iron treatments have become more popular. OBJECTIVES: The objective of this study was to evaluate the hematological parameters and to compare the efficacy and safety of postpartum moderate anemic patients while being treated with IV iron sucrose and oral ferrous sulphate. METHODS: A randomized comparative prospective clinical study was conducted in our hospital. In this study 100 women with postpartum anemia with hemoglobin (Hb) between 6 to 8 gm. percent after 24 hours postpartum were randomized into two groups. Group A consisted of 50 women who received 100 mg of IV iron sucrose on alternate day for 3 days along with 0.5mg of folic acid. Group B consisted of 50 women who received two tablets of ferrous sulphate 200mg twice daily for 30 days. RESULTS: Significant rise in Hb level was seen on day 7.14and 30 with IV iron as compared to oral iron. Mean rise in Hb level was 4.1 gm. % with IV iron as compared to 3.4 gm. % with oral iron on day 30 of treatment with P value less than 0.0001 which was significant. Mean rise in PCV level was 12.22% with IV iron and 10.46% with oral iron on day 30. Mean rise in MCV was 12.65u3 with IV iron and 7.9u3 with oral iron. Mean rise in MCH was 5.86pg with IV iron and 3.31pg with oral iron. Mean rise in MCHC was 5.52% with IV iron and 4.17% with oral iron. Mean rise in serum iron was 24.09ug/dl with IV iron and 18.95ug/dl with oral iron. TIBC levels drop by 185.14ug/dl with IV iron and 168.94Ug/dl with oral iron on day 30. CONCLUSION: These results suggest that IV iron sucrose increases the Hb level more rapidly than oral ferrous sulphate in