Effect of maternal blood transfusion versus maternal parenteral iron therapy on fetal vascular adaptation: an observational study in a tertiary care hospital in North India

Farheen Qureshi; Zarnain Abid; Sumaira Yousuf; Syed Masuma Rizvi; Jibran Bashir

doi:10.18203/2320-1770.ijrcog20253094

Authors

Farheen Qureshi Department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India
Zarnain Abid Department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India
Sumaira Yousuf Department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India
Syed Masuma Rizvi Department of Obstetrics and Gynecology, GMC Srinagar, Jammu and Kashmir, India
Jibran Bashir Department of Orthopaedics, SKIMS MC, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253094

Keywords:

Maternal anemia, Doppler ultrasound, Blood transfusion, Parenteral iron therapy, Fetal hemodynamics

Abstract

Background: Maternal anemia, particularly with haemoglobin levels below 7g/dl, is associated with significant fetal hemodynamic adaptations that may impact perinatal outcomes. This study aimed to evaluate the effects of maternal anemia on fetal doppler indices and assess changes after treatment with blood transfusion versus parenteral iron therapy.

Methods: A prospective study was conducted over a period of 12 months at GMC Srinagar, including 80 pregnant women (32-36 weeks gestation) with severe anemia (Hb<7g/dl). Participants were divided into two groups: Group 1 (blood transfusion) and Group 2 (parenteral iron therapy). Hematological parameters and fetal doppler indices (umbilical artery resistive index [UA RI] and middle cerebral artery resistive index [MCA RI]) were measured at admission, two weeks, and four weeks post-treatment. Statistical analysis was performed using SPSS Version 20.0.

Results: At baseline, Group 1 had significantly lower hemoglobin (5.69±0.54g/dl) than Group 2 (6.46±0.29g/dl, p<0.001). Post-treatment, Hb levels improved to 8.18±0.33g/dl (Group 1) and 8.05±0.22g/dl (Group 2, p=0.116), with a greater increase in Group 1 (2.48±0.77g/dl vs. 1.59±0.18g/dl, p<0.001). Doppler indices showed a significant reduction in UA RI and an increase in MCA RI in both groups (p<0.001).

Conclusions: Both blood transfusion and parenteral iron therapy effectively improved maternal hematological status and fetal doppler parameters. However, blood transfusion led to a faster correction of anemia. Regular doppler monitoring allows for timely assessment of fetal adaptation and intervention, improving perinatal outcomes.

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References

Onoh R, Lawani O, Ezeonu P, Nkwo P, Onoh TJP, Ajah L. Predictors of anaemia in pregnancy among pregnant women accessing antenatal care in a poor resource setting in South Eastern Nigeria. Sahel Medical Journal. 2015;18(4):182-87. DOI: https://doi.org/10.4103/1118-8561.176588

Bruno B, Mclean E, Egli I, Cogswell M. World Prevalence of Anaemia 1993–2005. WHO Global Database on Anaemia, World Health Organisation, Geneva, Switzerland, 2008.

Gramellina D, Folli MC, Raboni S. Cerebral-umbilical Doppler ratio as predictor of adverseoutcome. Obstet Gynecol. 1992;79:416-20. DOI: https://doi.org/10.1097/00006250-199203000-00018

Royal College of Obstetricians and Gynaecologiets. Green-Top Guideline 31. The Investigation and Management of the Small-for-Gestational-Age Fetus. 2nd ed. London: RCOG, 2013.

Sumpaico WW, Leung KY, Malhotra N et al. Doppler evaluation in fetal hypoxia. Ultrasound in Obstetrics and Gynecology. 1991;252:500.

Kurmanavicius J, Florio I and Wisser J. Reference resistance indices of the umbilical, fetal middle cerebral and fetal uterine arteries at 24-42 weeks of gestation. Ultrasound Obstetrics and Gynecology. 1997;10:112-20. DOI: https://doi.org/10.1046/j.1469-0705.1997.10020112.x

Stefanovic M, Milosavljevic M, Radovic-Janosević D, Kutlesic R, Vukomanovic P. Maternal anemia and fetal cerebral hemodynamic response-doppler assessment. Medicine and Biology. 2005;12(2):93-6.

Uche-Nwachi EO, Odekunle A, Jacinto S, Burnett M, Clapperton M, David Y, et al. Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago. Afr Health Sci. 2010;10(1): 66-70.

Tiwari M, Kotwal J, Kotwal A, Mishra P, Dutta V, Chopra S. Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. Med J Armed Forces India. 2013;69(1):31-6. DOI: https://doi.org/10.1016/j.mjafi.2012.07.016

Hassan R, Abdullah W, Nik Hussain. Anaemia and iron status of Malay women attending an antenatal clinic in Kubang, Kerian, Kelantan, Malaysia. Southeast Asian J Trop Med Public Health. 2005;36(5):1304-7.

Ghada A, Abdel Moety MD, Yossra SA. Effect of maternal iron deficiency anemia on fetal cerebral hemodynamic response by doppler and APGAR score. Med J Cairo Univ. 2012;80(1):235-40.

Ancuta E, Ancuta C, Iordache C, Chirieac R. P07. 14: Predictive value of Doppler assessment for the fetal umbilical and cerebral hemodynamic response in anemic pregnancies. Ultrasound in Obstetrics & Gynecology. 2009;34. DOI: https://doi.org/10.1002/uog.7110

Vyas S, Nicolaides K, Campbell S. Doppler examination of the middle cerebral artery in anemic foetuses. Am J Obstet Gynecol. 1990;162:10604. DOI: https://doi.org/10.1016/0002-9378(90)91317-6

Singh K, Fong YF and Arulkumaran S. Anaemia in pregnancy - a cross-sectional study in Singapore. European Journal of Clinical Nutrition. 1998;52:65-70. DOI: https://doi.org/10.1038/sj.ejcn.1600517

Kaur M, Chauhan A, Mohammad Muntafa Rajput. Maternal Anaemia and Neonatal Outcome: A Prospective Study on Urban Pregnant Women. Journal of Clinical and Diagnostic Research 2015;9(12):QC04-QC08. DOI: https://doi.org/10.7860/JCDR/2015/14924.6985

Allen LH. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr. 2000;71(5 Suppl):1280S-4S. DOI: https://doi.org/10.1093/ajcn/71.5.1280s