Anaemia During Pregnancy: Case Study

ANAEMIA DURING PREGNANCY

The wonder and joy ofpregnancyis matched by the body’s ability to adapt to looking after the growing baby. In addition to the mother’s physiologic needs, there is the additional need to provide the building blocks for optimal growth of the baby. All this construction requires energy and oxygen as the fuel that helps drive the engine.

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Oxygen in the air that we breathe is delivered to the cells of the body by haemoglobin, a protein molecule found in red blood cells. When the blood lacks level of healthy red blood cells or haemoglobin it leads to a condition called anaemia. The main part of red blood cells is haemoglobin that binds to oxygen. If red blood cells is too few or the haemoglobin is abnormal or low , the cells in the body will not get enough oxygen. The body goes through significant changes when a woman is pregnant.

Anaemia is a common disorder in pregnancy, which affect 20 to 60% of the pregnant women. About 20 to 30% of blood increases in the body, which increases the supply of iron and vitamins which are required in the production of haemoglobin. Most of the mothers lack adequate amount of iron during the second and third trimester of pregnancy. A mild anaemia is normal during pregnancy due to increase in the blood volume, but however a severe anaemia can put the baby at high risk of iron deficiency later in infancy. There are different types of anaemia that can develop during pregnancy such as fotal-deficiency anaemia vitamin B12, deficiency anaemia and iron deficiency anaemia. According to Cashion & Alden, Perry (2009)

In pregnancy, ladies need extra folate to make the red blood cells to transport oxygen to tissues throughout the body. Folate deficiency can directly contribute to certain types of birth defects. Folate-deficiency anaemia, folate which is also called folic acid, is a type of vitamin which is needed for the body to produce new cells, including healthy red blood cells. Iron-deficiency anaemia is when the body does not have enough iron to produce adequate amounts of haemoglobin, and is the most common cause of anaemia in pregnancy. To form healthy red blood cells the body needs vitamin B12 from her diet, the body would not be able to produce enough healthy red blood cells. Ladies who do not eat meat, poultry, dairy products, and eggs have a risk of vitamin B12 deficiency, which can lead to birth defects.

Severe or anaemia which is untreated can lead to preterm or low-birth-weight baby, postpartum depression, baby with a serious birth defect of spine or brain, prenatal mortality or maternal death. . Some of the symptoms of anaemia during pregnancy are pale skin, lips and nail, feeling tired or weak, dizziness, shortness of breath, and rapid heartbeat. Antenatal care refers to care given to a pregnant woman from the time of conception is confirmed until the beginning of labor. Risk factors for anaemia in pregnancy can be woman pregnant with more than one child, two pregnancies close together, vomiting a lot because of morning sickness, teenager who is pregnant, not eating enough foods that are rich in iron and heavy periods before became pregnant

In nursing process Assessment is the first stage in which nurse carries out a complete and holistic nursing assessment. Normal ward routine of nursing care procedures in antenatal unit at booking and important nursing focus areas is followed. Antenatal booking appointment, which provides the midwife with the valuable background information. The subjective and objective data is collected. The purpose of the visit is to bring together the woman to the maternity service. The information is shared between the mother and the midwife in- order to discuss, plan and implement care for duration of the pregnancy, the birth and postnatal period.

During my attachment in antenatal clinic a mother came in for antenatal booking. Collecting her personal history, she is Mrs X, Indian married female. Her date of birth is 22^th January, and is now 23 years old. , she is a high school graduate, is able to read and write and follow instructions, able to maintain eye to eye contact and is married to a 25 years old taxi driver named Mr Y. She is staying with her husband, his parents, two brother’s and a sister. They live in a wooden house near the copra mill. The mother is from Waibula but lives with relatives in Namara. Her emergency contacts were of her husband xxxxxxx and cousin sister xxxxxxx. Her family history, Mrs X mother is diabetic and her sister had twins. Mothers medical history was occasionally complains of migraine, and heavy menstrual bleeding. The husband and his elder brother are driving taxi and also they do a casual job in the timber mill. Mrs last normal menstrual period was on 25^th of September 2012, her expected date of delivery is on the 7^th of January 2013. She missed her period for two months. There was no gynaecological history present. Starting with her examinations, the height is 6 feet and 4 inches (1.65m) and is 66 kilograms. The urine test was normal, blood pressure was 80/40mmHg, temperature of 37.5°C,pulse rate: 114 bpm, respiratory rate: 28 bpm skin: (+) pallor, (-) jaundice, (-) cyanosis, head:, EENT: pale palpebral conjunctiva, negative cervical lymp adenpathy chest, lungs: symmetrical chest expansion, (-) retractions heart: adynamic precordium, tachycardia, (-) thrills, (-) murmur abdomen: globular, soft, normal and active bowel sounds, non-tender extremities: pale nail beds, cold upper and lower extremities (-) cyanosis, weak peripheral pulsesneurological: No found neurological deficits rectal exam: No haemorrhoids, no fissures, no masses, palpated, no tenderness, intact rectal vault, good sphincter tone. In the blood test, the full blood count was done and was low and proven to be anaemic. In order to ensure that the outcome of the pregnancy is the best for mother and baby, a routine is undertaken which is embraced by the term “ antenatal care”. Fraser and Copper (2009) stated “ the aims of antenatal care is to monitor the progress of pregnancy to .maternal and fetal health, developing a partnership with the woman, providing a holistic approach to the woman’s care that meets her individual needs, promoting an awareness of her public health issues for the woman and her family, exchanging information with the woman and her family, enabling them to make informed choices about pregnancy and birth, being an advocate for the woman and her family during her pregnancy, supporting her right to choose care appropriate for her own needs and those of her family, recognizing complications of pregnancy and appropriately referring woman to the obstetric team or relevant health professionals or other organizations, facilitating the woman and her family in preparing to meet the demands of birth, making a birth plan, facilitating the woman to make an informed choice about methods of feeding and giving appropriate and sensitive advice to support her decision and offering parenthood education within a planned programme or an individual basis”.(P.g 265).

During booking the mothers blood was sent in the laboratory for tests. The haemoglobin level 12g/dL or if it is the haematocrit less than 30% in a pregnant woman. Then it proves that the woman is anaemic. Mrs X haemoglobin level was 8.7g/dL and hemocrit was 25% , so it proved that she is anaemic. It is the risk to the mother and the fetus., So the nursing problem was diagnosed to Mrs X that she was suffering from Iron Deficiency Anaemia. Fraser et al. (2009) stated “ iron deficiency anaemia is the most common hematologic disorder in pregnancy, it affects approximately 15% to 25% of pregnant woman, depending on the ethnic and socioeconomic groups being studied”.(P.g 872). After the diagnosis of iron deficiency anaemia Mrs X was referred to the doctor.

The body produces more blood to support the growth of the body. The existence of a hematologic abnormally increases the pregnant women’s risk for developing more complication such as infection or preterm delivery If the mother not getting enough iron or certain other nutrients, the body might not be able to produce the amount of red blood cells it needs to make this additional blood. Taylor, Lillies, Lemone& Lynn (2011) stated “ carbohydrates’, protein and fats are potential sources of energy for the body”.(P.g 1158). Mrs X presented with symptoms of pale skin, lips and nails, feeling tired or weak, dizziness, shortness of breath, rapid heart rate and trouble concentrating. It is very important to assess the wellbeing of the fetus. This was done by checking the fetal movement and listening to the fetal heart sound using a fetal cardio graph machine. The bloods were performed to see the changes that may indicate worsening of anaemia.

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The nurses has its own independent role scope of practice to ensure that the mother and fetus are healthy. The nurses role in managing the pregnant woman in this case of Mrs X are as follows. Nurses can be councillor, collaborator and advocator. The role of the nurse at first step will be taking or monitoring vital signs of the mother and thefetal heart rate. To assess the fetal heart rate, fetal heart sound and fetal kick count was monitored. Urine check is another important role of nurse in monitoring an anaemic mother. The mother will be asked to bring along a urine sample for glucose and protein level. In early pregnancy if protein level will be high it can be sign of problems including urinary tract infection, a kidney disorder , high blood pressure or diabetes. If in later pregnancy protein of high level is found is sign of pre-eclampsia. Taking of height and weight measurements is another role of a nurse, also to work out body mass index. Potter, Perry, Stockert& Hill (2013) stated “ body mass index (BMI) measures weight corrected for height and serves as an alternative to traditional height-weight relationships”.(P.g 56). Since the nurse knows the diagnosis of Mrs

Mrs Xshe can advise on what kind of foods to consume .She was advised to take foods that are rich in iron examples are red meat, egg yolks, dark leafy vegetables, dried fruit, iron-enriched cereals, grains, chicken giblets, beans, lentils, and liver. Establishment of quiet and peaceful environment to promote rest. During her hospitalization Mrs X was served with full diet. The nurse also taught to the woman on correct positioning while resting.The nurses also did health education with the husband on health. Nurses need to follow the physicians orders in giving the prescribed medications on time.They also advised on personal hygiene.

In antenatal care the nurse needs to collaborate with other health care professionals, such as dietician, the obstetric, doctor, haematologists and physiotherapist. To enablepeople to make informed and practical choices about food and lifestyle in health and disease, the role of a dietician comes in, dietetics is the interpretation and communication of nutrition science. The role of a dietician was to prepare a food guideline for Mrs X. Obstetric team works with patients who are wanting to become to become pregnant, is pregnant or have recently delivered. The obstetricnurse have plenty roles in managing an anaemic mother. Mrs Narayan was admitted, reviewed, history taken, vaginal examination, fetal heart tones, and duration and intensity of contractions was done by an obstetric nurse. Paediatrician doctoradvised on healthy and successful delivery of Mrs Narayan, also advised on diet and medication compliance. Paediatrician doctor also took blood and urine test. The roleof midwife is to provide pregnancy care to woman during pregnancy and during birth. The midwife took Mrs X medical history and explained in detail the limitations and risks associated with pregnancy while being anaemic. The midwifealso checked urine for protein and heart beats for the developing baby. Health education was also provided by the midwife. The doctor was also responsible to prescribe medications, examination and to consider delivery if the condition of mother gets worse and fetus gets distressed. The physiotherapist taught Mrs X on exercise that was helpful to her.

There are rationales behind the nurses independent roles in ensuring the well-being of the mother and the fetus. As stated earlier monitoring of vital signs, it is very important because to see if Mrs X condition is stable or not. Also same for the fetal heart rate and fetal sounds to see if everything is normal or not. Monitoring fetal heart rate and fetal sound to ensure that the fetus is not distressed. Urine checkis also important factor, it is done by the nurses to see if the glucose and protein level is normal or requires attention. Taking of height and weight is also important to see if mother is healthy and gaining weight since she is pregnant.Also to calculate the body mass index of the mother. The nurse providing health education on her diet, encouraging her to take iron rich foods to prevent or stop Mrs X from getting anaemic. The nurse administers medication as prescribed by the doctors to make Mrs X to improve on her health.Personal hygiene is really important because the way mother keeps her self affects or reflects the fetus as well.

There are rationales behind the professionals collaborative roles in establishing or giving quality care to the pregnant mother. Taking of history from the mother is to know whether she had any past medical problems, such as gynaecological issues or any surgeries that can hinder her present pregnancy. Doctors or paediatricians take samples of blood to see if mother is seriously anaemic or requires attention, or to see if there could be any complications.The rationale of doctors doing vaginal examination is to see cervical dilation or any complications which can arise. Counselling by the doctors of having proper diet or dieticians, to improve the condition of the mother and avoiding complications. Obstetric team was to ensure that if emergency develops there could be urgent need to conduct delivery in caesarean section, because they have knowledge on when and how to conduct delivery in emergency situation. Doctors presenting medication to increase iron level in the blood. Physiotherapist needed to educate mother on exercise to help her in delivery.

During the end of the antenatal clinic, the strengths and weakness of Mrs X was found and identified, it was recorded in evaluation. Mrs X was adjusted to what the plan was ruled out for her. Her strengths were that she followed her diet to what the dieticians planned for her. The health education was really effective to her and her husband supported on her diet and growing fetus. The family support was also there and she was in happy environment, free of fear and anxiety. Mrs X also took her tablets on time and gained weight. Another blood test was done and was found out that her haemoglobin level was normal. The benefitsof maternal iron supplementation on these outcomes are unclear, even for woman who develop anaemia during pregnancy. There is vivid evidence that maternal iron deficiencyanaemia increases the risk of preterm delivery and low birth weight. Iron supplementsimprove the iron status of the mother during pregnancy and during the postpartum period, even in woman who enter pregnancy with reasonable iron stores. Through my point of view, the mass of evidence supports the practice of routine iron supplementation during pregnancy, even though iron is most common and important for woman who have anaemia.

( Approx: 2443 words.) Reference

• Potter, P, A., Perry, A, G., Stockert, P, A., & Hill, A, M. (2013). Fundamentals Of Nursing (8^th ed.). United States Of America: Mosby.
• Fraser, D, M., & Copper, M, A. (2009). Myles: Textbook for midwives (15^th ed.). Edinburgh: Churchill Livingstone.
• Lowdermilk, D, L., Perry, S, E., Cashion, K., &Alden, K, R. (2012). Maternity & Women’s Health Care ( 10^th ed.). United States Of America: Mosby.

• Taylor, C, R., Lillis, C., Lemone, P., & Lynn, P. (2011). Fundammentals Of Nursing: The art and science of nursing care (7^th ed.). Philadelphia: Lippincott.
• Reeder, S, J., Martin, L, L., &Martin, L, L. (1997). Maternity Nursing: Family, newborns, and women’s health care (18^th ed.). Philadelphia: Lippincott.

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