|Year : 2020 | Volume
| Issue : 3 | Page : 158-161
Analytical study to evaluate maternal morbidity and perinatal outcome among pregnant women with severe anaemia at tertiary care centre: A hospital-based study
Archana Meravi, Prachi Kushwaha, Indu Khare
Department of Obstetrics and Gynaecology, Peoples Medical College and Hospital, Bhopal, Madhya Pradesh, India
|Date of Submission||20-Jun-2020|
|Date of Decision||02-Aug-2020|
|Date of Acceptance||10-Aug-2020|
|Date of Web Publication||22-Sep-2020|
Department of Obstetrics and Gynaecology, Peoples Medical College and Hospital, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Background: Anaemia during pregnancy is a global public health challenge facing the world today. It is estimated that around 2 billion people, 30% of the world population, are affected with the majority coming from the developing world.Aim: The present study was conducted to assess perinatal outcomes and associated morbidity factors among anaemic pregnant women.Materials and Methods: The present study was a hospital-based observational study that was conducted in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India and included all the pregnant women in the third trimester of pregnancy with haemoglobin level <7 who were admitted between January 2016 to December 2017.Results: A total of 500 cases were enrolled for the study. The present study revealed that anaemia was significantly associated with co-morbidities, 25.4% women had pre-eclampsia, 7.6% had jaundice, 3.6% had heart disease and 4.8% had the intercurrent infection. Out of 500 anaemic women 216 women had severe maternal morbidity this was found to be significant (P = 0.016), 59 women had eclampsia in their antenatal period, septicaemia was found in 63 women, 32 had a pulmonary embolism. In this study, maternal morbidity among anaemic pregnant women (ICD-10) were found to be significant in the puerperal period, among 500 study participants, 41 women had puerperal pyrexia. 319 (63.8%) delivered the baby with low birthweight, 144 (28.8%) had full-term delivery, 34 (6.8%) were stillborn and 03 (0.6%) patients were undelivered. There was a statistically significant difference found in fetal outcome according to the urban or rural locality (P = 0.001). Conclusion: Low education level, gravidity and inter-pregnancy intervals are the main risk factor. We recommend educational awareness programme to be conducted amongst pregnant women to improve their knowledge regarding the causes and prevention of anaemia for a better antenatal and perinatal outcome.
Keywords: Anaemia, haemoglobin, low birth weight, perinatal outcome, preterm birth
|How to cite this article:|
Meravi A, Kushwaha P, Khare I. Analytical study to evaluate maternal morbidity and perinatal outcome among pregnant women with severe anaemia at tertiary care centre: A hospital-based study. Adv Hum Biol 2020;10:158-61
|How to cite this URL:|
Meravi A, Kushwaha P, Khare I. Analytical study to evaluate maternal morbidity and perinatal outcome among pregnant women with severe anaemia at tertiary care centre: A hospital-based study. Adv Hum Biol [serial online] 2020 [cited 2021 Apr 17];10:158-61. Available from: https://www.aihbonline.com/text.asp?2020/10/3/158/295838
| Introduction|| |
Iron deficiency anaemia, ranked as the fifteenth leading cause of disability-adjusted life years (DALYs) by the WHO in 2012.
Anaemia in pregnancy is a major health issue in developing countries like India because of lack of knowledge, poverty, ignorance and fewer intake of iron, folic acid and food source significantly contribute to this high prevalence. Almost 58% of the pregnant women are anaemic and it is estimated that anaemia is the underlying cause for 20%–40% of maternal deaths in India.
Anaemia in pregnancy accounts for half of all global maternal deaths occur in South Asian countries, out of which India contributes to 80%. According to a WHO review of nationally representative surveys from 1993 to 2005, anaemia affects approximately 42% of pregnant women worldwide (52% and 23% in developing and developed countries, respectively)., Anemia reduces women's energy and capacity for work and can; therefore, it causes household food insecurity and low income, also severe anaemia in pregnancy hampers oxygen delivery to foetus and resulting in intrauterine growth retardation, stillbirth, LBW and neonatal deaths. Hence, anaemia in pregnancy is responsible for the poor feto-maternal outcome and predispose to increased perinatal mortality and maternal morbidity and mortality. Keeping this view in mind, the study was carried out with the objectives to assess the perinatal outcome and evaluate the magnitude and risk factors of anaemia causing maternal morbidity and mortality.
| Materials and Methods|| |
The present study is a hospital-based Observational study that was conducted in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India. All the pregnant women at third trimester who were admitted at Sultania Zanana Hospital, Bhopal from January 2016 to December 2016, having haemoglobin level <7 g/dl were included in the study.
Sample size was drawn using formula 4pq/L2 where p = prevalence of anaemia, q = 1 − p and L = level of error. According to this, the sample size was calculated to be 500.
- All pregnant women at third trimester admitted at our institute, SZH
- Antenatal mothers who are willing to participate in the study
- Who are present at the time of data collection
- Who can understand and communicate in Hindi.
All admitted cases of anaemia came with antepartum haemorrhage and shock, who were subjected to blood transfusion in the last 3 months and with a history of some diseases that may affect the result such as; liver disease, renal disease, diabetes mellitus were excluded.
Data collection and statistics analysis
Data were collected using instructed writing questionnaire by interviewing: regarding the patient name, age, residence, antenatal booking status, gestational age, education, socio-economic status, number of gravidity, blood groups, previous blood transfusion, history of diseases supportive supplements and tea intake, maternal follow-up, interpregnancy interval. Gestational age was assessed from the date of the last menstrual period and only term pregnancies were included in the study. Data were analysed by Data were analysed by SPSS software (Version 22.0 IBM; Chicago;USA). Comparison among clinical variables was performed with Person Chi-square test. All tests were two-tailed and the statistical significance was set as P < 0.05.
| Results|| |
Five hundred pregnant women were selected for the study to identify the risk factors that contribute to the presence and severity of anaemia to assess maternal morbidity and mortality and to evaluate the foetal outcome. Anaemia was more prevalent amongst 21–35–year–old study subjects.
Out of 500 anaemic pregnant women, most (74.2%) were 21–35 years old followed by women <20 years old (18.8%). Only 35 (7.0%) were more than 35 years old. Of the all patients, 68.6% were multigravidas and 20.2% were grandmulti and 11.2% were primigravida. Among these anaemic pregnant women, 121 (24.2%) were illiterate and most of 215 (43.0%) were below 10th standard. 161 (32.2%) were high school graduates and only 03 (0.65%) were college graduates. Anaemia was more prevalent among low socioeconomic class. Out of 500 anaemic pregnant women, 327 (65.4%) were low-income class. 149 (29.8%) were of middle-income class and 24 (4.8%) were of high income class (P = 0.33 [S]). Anaemia was more prevalent among rural population as compared to the urban population. Out of 500 study subjects, 314 (62.8%) were from the rural locality and 186 (37.2%) from an urban location (P = 0.001 [HS]).
The present study revealed that anemia was significantly associated with co-morbidities 25.4% women had pre-eclampsia, 7.6% had jaundice, 3.6% had heart disease and 4.8% had the intercurrent infection. Out of 500 anaemic women 216 women had severe maternal morbidity; this was found to be significant (P = 0.016), 59 women had eclampsia in their antenatal period, septicaemia was found in 63 women, 32 had pulmonary embolism. In this study, maternal morbidity among anaemic pregnant women (ICD-10) were found to be significant (P = 0.036) in the puerperal period, among 500 study subjects 41 women had puerperal pyrexia, 32 women had puerperal sepsis, 1n 19 women subinvolution was found, 19 women had episiotomy gaping and abdominal wound gap was found in 3 women [Table 1].
|Table 1: Incidence of co-morbidities among anemic pregnant women (n=500)|
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Out of 500 pregnant women, 356 (71.2%) undergone preterm vaginal delivery, out of 352 preterm delivery, 265 (53%) were spontaneous and 88 (18.2%) were induced. 100 (20.2%) undergone full-term vaginal delivery and 44 (8.8%) undergone caesarean section [Table 2].
Out of 500 study subjects, most of 41 and 32 had Puerperal Pyrexia and Puerperal Sepsis. Subinvolution was seen in 2 subjects. Epsiotomy Gap was seen in 19 subjects, and Abdominal Wound Gap was seen in 3 patients. There was a statistically significant association was found between maternal morbidity and haemoglobin (P = 0.036) [Table 3].
Out of 500 study subjects, 319 (63.8%) delivered baby with low birth weight, 144 (28.8%) had full term delivery, 34 (6.8%) were stillborn and 03 (0.6%) patients were undeliverd [Table 4].
Out of 319 low birth weight baby, 200 were from rural and 119 were from urban. Still born were seen in 20 rural and 14 urban population. There was a statistically significant difference found in foetal outcome according to the urban or rural locality (P = 0.001) [Table 5].
|Table 5: Association of fetal outcome with urban or rural locality among anemic pregnant women|
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| Discussion|| |
Anaemia and iron deficiency are common during pregnancy., A small decrease in haemoglobin (Hb) is a normal physiological consequence of the increase in blood plasma volume during pregnancy. Normally, after an initial increase (due to the cessation of menstruation), Hb levels decrease by around 20 g/l and reach their lowest level during the second trimester, returning to pre-pregnancy levels as the pregnancy advances towards term., In the case of iron deficiency anaemia during pregnancy, there are several possible risks to the mother, including increased fatigue, short term memory loss, decreased attention span and decreased performance at work, increased pressure on the cardiovascular system due to insufficient Hb and low blood oxygen saturation levels, lower resistance to infections and a reduced tolerance to significant blood loss and to surgical intervention during labour., The presumed risks of iron deficiency for the foetus relate to the fact that low iron levels increase the risk of reduced Hb levels, and therefore oxygen to the placenta and the foetus during development. Moreover, iron-deficient neonates have been shown to have a statistically significant increment in both cognitive and behavioural abnormalities up to 10 years after iron repletion. Hence, it is observed that severely anaemic women associated with unfavourable obstetrics outcomes, notably, premature birth, low birth weight and foetal death.,,
The present study revealed that anaemia was significantly associated with co-morbidities, 25.4% women had pre-eclampsia 15.2% had eclampsia, 7.6% had jaundice, 3.6% had heart disease and 4.8% had the intercurrent infection.
We found that out of 500 anaemic women 216 women had severe maternal morbidity this was found to be significant (P = 0.016), 59 women had eclampsia in their antenatal period, septicaemia was found in 63 women, 32 had pulmonary embolism, 12 women had surgical procedure for cardiac disease, acute renal failure (ARF) were found to be in 11 subjects, 21 subjects had need of mechanical ventilation and 08 women had transfusion reaction.
In our study, maternal morbidity among anaemic pregnant women (ICD-10) were found to be significant (P = 0.036) in the puerperal period, among 500 study subjects 41 women had puerperal pyrexia, 32 women had puerperal sepsis, 1n 19 women subinvolution was found, 19 women had episiotomy gaping and abdominal wound gap was found in 3 women. Similar results were observed by other studies conducted in the country, suggesting that iron deficiency significantly increase the morbidity in females.
In our study, 71.2% had pre-term vaginal delivery, 20.0% had full-term vaginal delivery. The present study revealed that out of 71.2% pre-term delivery, 53.0% had spontaneous vaginal delivery and 17.6% had induced vaginal delivery.
Anam et al., in their study concluded that (58.9%) patients had normal vaginal delivery. In the present study, we found that among all severely anaemic pregnant women 45.2% had normocytic hypocromic anaemia, 43.6% had microcytic hypochromic anaemia and 11.2% had macrocytic hypochromic anaemia
Rawat et al., showed in his study that microcytic hypochromic anaemia 51% was most prevalent, other morphological types reported as normocytic normochromic anaemia, dimorphic anaemia and macrocytic anaemia as 32%, 13% and 4% respectively. Similar findings were reported in the study by Sawereported prevalence was 53.6%.
Karaoglu et al., in his study found that 56.5% pregnant women had normocytic– normochromic anaemia and 38.1% had microcytic–hypochromic anaemia.
In our study, we found that 46.4% of babies delivered with low birth weight, 50.2% of cases were of intra-uTerine growth retardation and 3.4% were stillborn. Induction was done in terms of maternal indication so the babies were pre-term.
Shrivastava et al., showed in her study 11.25% had severe IUGR. Kumar et al., revealed in his study 11.5% preterm delivery who were anaemic in their third trimester. Zhang et al., 2009, reported in his study preterm birth rates was 4.1%.
| Conclusion|| |
Contrary to expectation in our study women who reported consuming iron supplements and were booked significantly had low Hb and contributes substantially to the increased maternal and perinatal morbidity and mortality, and poor foetal outcome.
The larger population is still having home delivery. Maternal morbidities and mortalities are also under reported. The magnitude of the problem may be beyond our expectation. Henceforth, more efforts are required to strengthen the health system at the primary level to prevent anaemia and related complications in pregnancy. We need to focus more on primary prevention, i.e., adolescent health, nutrition, preconceptional counselling and good antenatal care, increasing family planning practices and tertiary prevention that emphasise on early identification.
Although the adopted strategy concerning primary health care refers to be well planned and it has no noticeable effect on the improvement of prevalence of IDA in the last 10–15 years, there is a greater need for further health education and promotions programme in this respect.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guidelines for Control of Iron Deficiency Anemia: National Iron + Initiative. Adolescent Division Ministry of Health and Family Welfare, Government of India. New Delhi: nhm.gov.in/images/pdf/Programmes/Child-health/guidelines/control-of-Iron-Deficiency-Anaemia.[Cited on 06/06/2020]; 2013: p. 5-12.
Noronha JA, Khasawneh EA, Seshan V, Ramasubramaniam S, Raman S. Anemia in pregnancy-consequences and challenges: A review of literature. J South Asian Feder Obst Gynae 2012;4:64-70.
Benoist BD, McLean E, Egli I, Cogswell M. Worldwide Prevalence of Anemia 1993-2005: Who Global Database on Anemia. Geneva, Switzerland: WHO; 2008.
Sanghvi TG, Harvey PW, Wainwright E. Maternal iron- folic acid supplementation programes: Evidence of impact and implementation. Food Nutr 2010;31 Suppl 2:S100-7.
Cao C, O'Brien KO. Pregnancy and iron homeostasis: An update. Nutr Rev 2013;71:35-51.
Burke RM, Leon JS, Suchdev PS. Identification, prevention and treatment of iron deficiency during the first 1000 days. Nutrients 2014;6:4093-114.
Scholl TO. Iron status during pregnancy: Setting the stage for mother and infant. Am J Clin Nutr 2005;81:S1218-22.
Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr 2001;4:537-45.
Anam A, Maleeha M, Nadia M, Abdullah SH. Prevalence of anemia during pregnancy in district Faislabad, Pakistan. Punjab Univ J Zool 2015;30:15-20.
Rawat K, Narendra R, Navgeet M, Medha M, Nitesh C, Rahul K, et al.
Prevalence and pattern of anemia in the second and third trimester pregnancy in Western Rajasthan. Int J Res Med Sci 2016;4:4797-9.
Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, et al
. The prevalence of nutritional anemia in pregnancy in an east anatolian province, Turkey. BMC Public Health 2010;10:329.
Shrivastava M, Soni P, Sinha U, Chanchalani R. Study of haemoglobin levels in pregnant women and its various effects on pregnancy outcome. J Evol Med Dent Sci 2014;3:2740-5.
Kumar KJ, Asha N, Murthy DS, Sujatha M, Manjunath V. Maternal anemia in various trimesters and its effects on newborn weight and maturity: An observational study. Int J Prev Med 2013;4:193-9.
Zhang Q, Ananth CV, Li Z, Smulian JC. Maternal anaemia and preterm birth: A prospective cohort study. Int J Epidemiol 2009;38:1380-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]