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Haemoglobin levels in pregnancy and the puerperium. A clinical study of 104 cases with critical survey of the literature

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HendersonWK_1942redux.pdf (29.33Mb)
Date
1942
Author
Henderson, William Kerr
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Abstract
 
 
Haemoglobin levels in pregnancy And the puerperium: a clinical study of 104 gases with critical survey of the literature
 
One hundred and four cases of pregnancy, described and considered in the light of previous work, have been presented. It has been shown that the majority of the cases could be considered normal in regard to the blood picture which they presented and these normal cases have been used to demonstrate the normal behaviour of the blood in pregnancy and the puerperium.
 
The striking feature in pregnancy is the occurrence of the hydraemia, which seems to have been the cause of much confusion in the literature, particularly when the results of iron administration have been considered. We have endeavoured to show that this reduction in the haemoglobin during the second and most of the third trimesters of pregnancy is physiological and not influenced significantly by the administration of iron during pregnancy. The consideration of the iron treated groupsbore this out, while a study of the initial haemoglobin levels at various stages in pregnancy, and the haemoglobin levels at various stages in groups treated for periods up to 20 weeks, also confirmed this since the general curve of the haemoglobin level during pregnancy was comparable in each group studied. The period of gestation is therefore the chief factor in determining the haemoglobin level found in any normal case. In the puerperium, the normal behaviour of the blood was considered, and the treated groups, as previously described, were shown to hold no advantage over the normal.
 
The thesis therefore seems to be maintained, that . there is no advantage to be derived from iron administration in pregnancy, the puerperium or both, either to the mother or child if the former be not anaemic.
 
It was shown that the incidence of anaemia in pregnancy, exclusive of secondary anaemia, only amounted to little over l0á and therefore it seems reasonable to say, that routine iron therapy is not justified in order to benefit this minority. The anaemic cases can easily be found by routine haemoglobin estimation during ante -natal examinations.
 
The benefit of iron to anaemic cases, of the type found in this series, is undoubted whether the anaemia occurs in pregnancy or the puerperium and whether of the primary nutritional or the secondary type.
 
The slight advantage in the puerperal recovery of the blood from the administration of iron in pregnancy, to those suffering from an iron lack as a result of haemorrhage at delivery, has been shown, but the numbers involved are so small as not to justify routine iron therapy.
 
The onset of complications of pregnancy, labour and the puerperium was not found to be related in any way to iron therapy in normal cases and therefore this also does not justify routine iron therapy. Anaemic cases are probably more prone to septic infection but not to the other complications of pregnancy, labour or the puerperium; iron therapy by restoring the blood level to normal increases the resistance of these cases to infection.
 
Since this study was undertaken from a practical, clinical standpoint, it may be said that the point of chief interest is the need for routine haemoglobin estimation in pregnancy in order to find out and treat any anaemic cases. This seems more scientific and sensible than the routine administration of iron in pregnancy. The ideal, of course, would be the prevention of anaemia in adult women by proper dietary, which in addition would ensure an adequate intake of other minerals and vitamins no less important than iron. The attainment of this goal is not yet in sight and until this ideal is reached it is better that we should make good any deficiency known to exist, either from a study of the diet and its correction where possible or from clinical observation of any deficiency and its treatment as exemplified by this study of anaemia, rather than administering drugs routinely to many who have no need of them.
 
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http://hdl.handle.net/1842/32410
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