2.10.3.6. Hb <100g/l: Women who have had a caesarean section or instrumental delivery are less likely to absorb oral iron as their hepcidin levels will be higher (due to the inflammatory response to surgery). Offer 1g IV iron to these women.
2.10.3.7. For all other women with Hb <100g/L offer alternate day oral iron. If Hb <80g/l or symptomatic of anaemia, offer 1g IV iron.
2.10.3.8. Repeat FBC and ferritin at 6 weeks by GP to ensure Hb and iron stores are replete.
2.10.3.9. Hb <60g/l: Give 1g IV Iron (Ferinject). Discuss options with woman. Assess clinical picture (symptoms, signs, haemodynamic stability). Consider 1 unit of blood following informed consent (this should be a single-unit transfusion with a repeat Hb to determine the need for further transfusion).
2.10.3.10. One red cell concentrate contains approximately 240 mg of iron, which is insufficient to replenish iron reserves. Therefore, concomitant IV iron to replete iron reserves is safe.
2.10.4. Symptomatic Anaemia
Women who are symptomatic of anaemia, haemodynamically unstable or continuing to bleed heavily will need a full senior obstetric review to investigate the origin of the blood loss and decide further management. Other speciality involvement may be indicated.
Follow up arrangements with primary care should be ensured at postnatal discharge from hospital.
2.11. Management of labour and delivery in woman with iron deficiency anaemia
With good practice this situation should be avoided, however there are instances when women book late, have not engaged in antenatal care, or moved from out of the county. In such situations take all measures to minimise blood loss at delivery. Women with Hb <100g/L should have an obstetric led birth within hospital. Home birth and midwifery led birth may be considered in women with Hb >100g/L.
2.11.1. Women with Hb <100g/L should have an obstetric led birth: deliver in hospital with IV access, and FBC and group and screen on admission.
2.11.2. Active management of third stage (refer to Third Stage of Labour Clinical Guideline).
2.11.3. Consider prophylactic Syntocin on infusion / Misoprostol (Alfirevic 2007).
2.11.4. In the event of a PPH, there will be a tendency to decompensate quicker, so all measures to stop bleeding should be performed promptly.
Anaemia and iron deficiency: Diagnosis and Treatment throughout Pregnancy, Labour and Postpartum Period Clinical Guideline V4.3