Book of Medical Disorders in Pregnancy - Tintash

Prophylactic this includes routine
administration of iron during pregnancy
and lactation. Iron supplementation
should start after the sixteenth week of
pregnancy in order to avoid increase in
the early vomiting of pregnancy. If the
patient's initial hemoglobin level is over
90 per cent or 11 gram per cent then she
requires only a single dose of 200 mgm
of ferrous sulphate. Each tablet of 200
mgm of ferrous sulphate contains 60 mg
of elemental iron. If the hemoglobin
level is less than 90 per cent she should
receive 180mg. of elemental iron, which
can be given daily in divided doses after
meals.
When ferrous sulphate or gluconate is
not tolerated well by the patient, ferrous
succinate or ferrous fumarate may be
tried. A number of preparations such as
fefol, feospan and autrin are available in
the market; some of these have been in
use for many decades without any side
effects and therefore can be safely
prescribed. Amino-acids are an essential
part of the hemoglobin molecule, there
fore all pregnant women should be
encouraged to drink milk and eat meat.
Therapeutic:
Iron in therapeutic doses can be
administered by oral, intramuscular or
intravenous route. Oral route is preferred
in treatment of outdoor cases, while
intramuscular injections are
recommended in patients where rapid
increase in hemoglobin is needed.
Some patients are unable to
tolerate iron by mouth, they also need
intramuscular therapy. Some of the
commonly used iron preparations for
intramuscular administration include the
following.
Iron sorbitol citric acid complex
(Jectofer):
This preparation contains 50 mg of
elemental iron in one milliliter solution.
Each injection of 2 ml. of Jectofer may
be expected to raise the hemoglobin by
about 0.3 gram per hundred milliliters of
blood.
Imferon: Iron can also be given by
intravenous route. Imferon is an iron
dextran complex which is available in 5
ml ampoules and contains 100 mg of
iron. In pregnant patients each 100 mg of
iron can raise the hemoglobin by about
0.3 per cent. Total dose of iron required
to meet deficiency of hemoglobin can be
mathematically calculated by using the
formula shown in table (31). This compound
must not be allowed to leak
outside the vein as it is extremely irritant
and can cause thrombophlebitis.
The total dose of iron, as iron dextran, is
mixed with 1000 ml of normal saline
solution, 8,000 units of heparin are
added in this to discourage venous
thrombosis. The drip should be run at a
rate of 10 drops per minute for fifteen
minutes and then, at 45 drops a minute
until the infusion is completed, and this
should take about five hours. The drip
should be stopped on the slightest
evidence of adverse reaction and 50
mgm of Phenergan along with 100 mgm
of hydrocortisone should be given to
avert exacerbation of reactions.
When iron is administered
intravenously, a shower of renal casts
and leucocytes often appears in the
maternal urine.
Intravenous total dose iron therapy
should be avoided in patients who have a
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