[Postpartum anemia--incidence and etiology]

Anemia is the most common puerperal complication which increases the risk of maternal morbidity in postpartal period with incidence of up to 56% of women. In 90% cases the etiology of postpartal anemia is decreased serum iron level. Postpartal hemorrhage (loss of blood more than 0.5 L during labor) is the cause of anemia in 5-10% of women.

This prospective study included 4009 postpartal women with normal pregnancy and delivery who gave birth during the year 1997 at our Department. There were 3305 women with vaginal delivery and 704 women who had cesarean section. Anemia was diagnosed when the hemoglobin serum concentrations were less than 100 g/L (6.21 mmol/L) and hematocrit less than 0.31.

Although about three quarters of pregnant women had 8 and more obstetrical controls and 3 and more ultrasound examinations during pregnancy, only half of them had blood count control 3 or more times. Blood count was checked 3 or more times during pregnancy in 54.98% women and 32.9% of all women took iron medication during pregnancy but no longer than 12 weeks. Before pregnancy 0.6% of women had anemia, and after the delivery that number increased to 25.41% with no significant differences between those who had vaginal delivery and those with cesarean section. The incidence of newborns with anemia was 5.11% in both groups. These results show that anemia of mother has no influence on anemia of the newborn who has its own mechanisms of compensation. The etiology of puerperal anemia was in 79.18% women caused by low serum iron levels with no differences between both groups, but infection caused anemia was more frequent in women with cesarean section (11.8%) than in women with vaginal delivery (0.36%).

Although one third of pregnant women take iron medication during pregnancy, every third woman has anemia after delivery, both vaginal delivery and cesarean section. Women who had cesarean section had anemia more frequently caused by infection. Anemia is 5 times more frequent in the mother than in her newborn. Prophylactic iron medications during pregnancy are not recommended, but more frequent control of blood count during pregnancy is required, as well as adequate therapy of anemia.