Obstetric Anaemia toolkit

This toolkit is for midwives and obstetricians to help implement good practice within hospital and community settings

The toolkit provides a pathway to identify, diagnose and treat iron deficiency anaemia during pregnancy and the postpartum period. It demonstrates how Patient Blood Management initiatives can help prevent iron deficiency and iron deficiency anaemia from occurring.

Identifying obstetric anaemia

The British Society of Haematology and the Royal College of Obstetricians and Gynaecologists identify obstetric anaemia as a haemoglobin of:

- less than 110 g/L during the first trimester

- less than 105 g/L during the second and third trimester

- less than 100 g/L postpartum

decorative image of a pregnant woman, blood drop

Risks related to obstetric anaemia

Obstetric anaemia can cause extreme fatigue, and increase the risk of infection, postpartum haemorrhage and depression. In neonates, it can increase the risk of low birthweight, impaired cognitive function and iron deficiency anaemia.

Support the World Health Organisation (WHO) call to action

A WHO policy brief in 2017, urged health care providers to implement Patient Blood Management initiatives to minimise the negative impact of anaemia on pregnant women / people and neonates.

This toolkit supports the global initiative to reduce obstetric anaemia by 50% by 2025.

In the UK this equates to a reduction from just under 25% of the pregnant population, to around 12%.

Guidance

For promoting good practice

Management of obstetric anaemia (PPTX 642KB) for obstetricians and midwives

Antenatal anaemia optimisation pathway flowchart (PDF 157KB) produced by The Royal Free NHS hospitals

Obstetric IV iron prescription and administration guideline (PDF 620KB) produced by The Royal Free NHS hospitals

IV iron prescription sticker for patients notes (PDF 195KB) produced by NHSBT Patient Blood Management

For health care professionals

Online training

Module 1 covers definitions of anaemia in pregnancy, symptoms, causes and impact of anaemia.

Module 2 covers screening and investigations, dietary considerations, and treatment.

If you would like a certificate on completion, please sign into ESR or e-learning for health

For open access without a certificate see:
Maternal Anaemia (part one)
Maternal Anaemia (part two)

Resources

Implementing PBM measures in a labour ward setting: lessons for the labour ward (PDF 1227KB)

For midwives in community and hospital settings: iron deficiency (PDF 1406KB)

Information on tranexamic acid (PDF 360KB) and intraoperative cell salvage (PDF 341KB)

For audit

Data collection tool (XLSM 24KB); please enable macros to use.

Instructions (PDF 104KB) for data collection, and analysis for an audit / project.

NHS advice in pregnancy

Infographics

What is iron deficiency anaemia? (PDF 64KB)

What is iron deficiency anaemia?

Iron is an important building block for making haemoglobin, the part of your red blood cells that deliver oxygen to every cell in your body. Iron deficiency anaemia can occur if you do not have enough stored iron to make the haemoglobin you need.

During pregnancy your body needs three times the amount of iron than when you are not pregnant.

It is estimated 1 in every 4 pregnant women in the UK are anaemic.

How will I know if I am anaemic? (PDF 65KB)

How will I know if I am anaemic?

A blood test will be taken at your first pregnancy appointment - ideally by 10 weeks of pregnancy and again at 28 weeks of pregnancy.

The test measures your haemoglobin. Sometimes an additional test is done to measure serum ferritin - this shows how much stored iron you have.

If your medical history or diet increases your risk of anaemia, the blood test will be repeated at 20-24 weeks of pregnancy.

How can anaemia make you feel? (PDF 217KB)

How can anaemia make you feel?

Tired and irritable, unable to concentrate, headaches, dizziness, unusual cravings - craving ice or soil, breathless, palpitations, hair loss, paleness, feeling cold.

What are the risks? (PDF 85KB)

What are the risks?

Risks to the mother can include extreme tiredness, postnatal depression, decreased milk supply, very heavy bleeding after birth, more likely to need a blood transfusion.

Risks to the baby can include low birth weight, premature birth, risk of iron deficiency anaemia as an infant.

How can I prevent anaemia? (PDF 151KB)

How can I prevent anaemia?

Eat more: meat and chicken (well cooked, avoid liver in pregnancy), dark green vegetables (wash well), beans, lentils, chickpeas, oily fish (salmon, sardines, mackerel, limit to two portions per week), nuts, seeds and dried fruit.

Have less: tea and coffee - avoid one hour before and after meals. These drinks contain tannins which reduce iron absorption.

Am I at risk of iron deficiency anaemia? (PDF 67KB)

Am I at risk of iron deficiency anaemia?

Risk factors can include anaemia in a previous pregnancy, aged under 20 and pregnant, twins or more in this pregnancy, three previous births or more, not eating enough iron rich foods, certain medical conditions, less than one year since last pregnancy.

Treating anaemia with iron tablets (PDF 519KB)

Treating anaemia with iron tablets

If you are less than 34 weeks, you may be prescribed iron tablets. You may be advised to keep taking the tablets for 3 months or until 6 weeks after the birth.

If possible, take them on an empty stomach.

Vitamin C may help absorption of iron.

Some people have side effects. This can include nausea, diarrhoea, or constipation. Tell your doctor or midwife if this affects you.

A blood test to check your haemoglobin will be repeated at 2 to 3 weeks after you have started treatment with iron.

Treating anaemia with an iron infusion (PDF 63KB)

Treating anaemia with an iron infusion

If you are more than 34 weeks or anaemia is making you very unwell, you may receive an iron infusion into your veins. This usually takes place in the hospital and does not require an overnight stay.

A blood test to check your haemoglobin will be repeated at 2 to 3 weeks after you have started treatment with iron.

This toolkit supports the implementation of the pathway for obstetric anaemia and is for you to edit and use in your practice; please acknowledge the PBM England Obstetric Anaemia Project when you use them.