Author: Davies, J. B.; Fontaine, E.; Sprigge, K.
Title: P.84 Managing maternal anaemia at Royal Cornwall Hospital: Iterative improvements year on year Cord-id: rojfp4hj Document date: 2021_1_1
ID: rojfp4hj
Snippet: Introduction: Maternal anaemia remains common despite associations with adverse maternal and fetal outcomes.1 Recently, conventional definitions of anaemia ([Formula presented]10g/L) have been questioned and a higher haemoglobin threshold ([Formula presented]20g/L) suggested.2 This is likely to benefit a population at risk of significant blood loss. Methods: In 2019, haemoglobin results of women requiring elective caesarean section were audited during pregnancy and after surgery. Subsequently, c
Document: Introduction: Maternal anaemia remains common despite associations with adverse maternal and fetal outcomes.1 Recently, conventional definitions of anaemia ([Formula presented]10g/L) have been questioned and a higher haemoglobin threshold ([Formula presented]20g/L) suggested.2 This is likely to benefit a population at risk of significant blood loss. Methods: In 2019, haemoglobin results of women requiring elective caesarean section were audited during pregnancy and after surgery. Subsequently, changes were made to the Anaemia in Pregnancy Guideline: treatment flow charts were simplified and the Ferinject dose was maximised to 1000 mg. Re-audit took place in 2020. Results: Data were collected for 100 women in 2019, and 135 women in 2020. In both years anaemia prevalence at booking was low (2.2% and 0.7%, respectively). In 2019, 8 women missed booking blood tests compared to only 3 in 2020: an improvement despite the challenges of Covid-19. All anaemic patients were prescribed oral iron. In both years anaemia prevalence increased at 28 weeks. In 2019 all women were again prescribed oral iron, but only 77.8% were followed up. 3 women remained anaemic despite oral iron therapy, but only 2 were offered Ferinject 500 mg. In 2020 only 2.2% missed followed up. Ferinject 1000 mg was administered to 3 women who did not respond to oral iron, or developed anaemia later in pregnancy. In both years one third of anaemic women developed anaemia in the third trimester despite having appropriate haemoglobin levels at 28 weeks (33% in 2019 and 34% in 2020). Post-operatively 16.3% of women were anaemic in 2019 reducing to 11.1% in 2020. [Formula presented] Figure: Antenatal and post-caesarean anaemia prevalence Discussion: Despite improvements between 2019 and 2020, anaemia still persists unacceptably in the elective caesarean section population despite readily available treatment. A third of women developed anaemia later in pregnancy despite following guidelines. This supports targeting a higher haemoglobin (120g/L) throughout pregnancy to mitigate for anaemia worsening towards term.
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