Fetal vascular adaptation before and after treatment of severe maternal anemia after 32 weeks of pregnancy
Dr. Surekha Janjgir, Dr. Manju Sharma, Dr. Lata Rajoria and Dr. Seema Mehta
Introduction: Anemia among pregnant women is a serious global health concern. It is well known that pregnant women are susceptible to haematological abnormalities that may affect any women of child bearing age. Distribution of fetal blood flow (between the placenta and cerebral region) is determined by the ratio between the cerebral resistance index (CRI) and umbilical resistance index (URI). The combination of increased placental resistance and decreased cerebral resistance, measured using Doppler ultrasonography, is quantified by calculating the cerebral-to-umbilical artery resistance ratio.
Aim: of study is to improve perinatal morbidity and mortality by adequately and timely correction of severe maternal anemia.
Materials and Methods: 30 patients fulfilling inclusion and exclusion criteria selected from the labour room of MCSG, SMS Medical College, Jaipur, with hemoglobin level < 7g/ dl. All the patients underwent Color Doppler sonography at admission further blood transfusion & Iron transfusion was according to Hb level and follow-up done after 10 & 20 days of transfusion. Continuous variables will be summarized as mean and SD and will be analysed by unpaired and paired T test. Nominal and categorical variables will be summarized as proportion (%) and will be analysed by using chi square test and Fisher exact test.
Observations: The study shows that the ratio of mean CRI/ mean URI was 1.22 ± 0.14 at the time of admission and 1.36 ± 0.11 after 10 days of admission that was increased by 0.15 ± 0.02 from the day of admission and it was statistically significant (P<0.001). After 20 days of admission, it was 1.50 ± 0.15, increased by 0.29 ± 0.03 from the day of admission that was statistically significant. In this study, 50% newborns were low birth weight (<2.5kg) and 50% were normal birth weight (>2.5kg). This shows, uteroplacental insufficiency was the cause of low birth weight babies. One more cause would be preterm birth.
Conclusion: Anaemia in pregnancy is one of the causes of poor perinatal outcome like high risk of low birth weight, IUGR babies, low APGAR scores and NICU admissions and overall increases perinatal mortality and morbidity. Hence proper antenatal care and counselling can reduce the occurrence of anaemia in pregnancy. Close monitoring of the fetal umbilical and cerebral circulation by Doppler examination in anemic pregnancies allows the measurement of the amplitude of the fetal vascular response and the fetal recovery as well.