Dr. Hemant Deshpande: Anemia In Multifetal Pregnancy | Emcure AICOG tv

Welcome to AICOG 2018, Bhubaneswar I am Dr. Shahu Ingole and you are watching me live on Emcure AICOG tv. I am glad to have with me the eminent personality Dr. Hemant Deshpande sir from Pune. Thank you. Sir is the Professor and Had Department of obstetrics and gynecology, Dr. D. Y. Patil Medical College, Pune so welcome to the show sir. Thank you. So sir in relation to your recent talking AICOG 2018. We all know that the burden of anemia is increasing globally as well as in India so in relation to that how common anemia is as far as that mean pregnancies concern. If you see the incidence of the anemia in twin pregnancy. It is practically 80% because twins are much more prone for having anemia in antenatal period and it is reasonably earlier than the single-term pregnancy. The twin pregnancy the hemodilution that is much more than the single-term pregnancy. The plasma volume that it is increased practically up to 65% which is in single pregnancy up to 50% and RBC volume increase will remain same that is 17 to 25% hence the hemodilution in multiple pregnancy or twin pregnancy is much more and these people they are having physiological anemia. The needs of the mother, the needs of the twin and obviously the dietary factors, the absorptions factors and many more thing that make patient to develop the anemia in the second trimester onward along with the exaggerated physiological anemia in pregnancy so she is a patient, who need to be supplemented right time, right Iron that’s what I can say. Right Iron, right time and right dose if these 3 things are there you can tackle the anemia in multiple pregnancy. The dose of the Iron requirement in twin pregnancy has to be increased. She has to have the supply to the twins, two babies so automatically the maternal need, the need of the placenta, the need of the twin pregnancy that makes increase in supplementation of elemental Iron. Usually, we give around 60 mg of the elemental Iron in a single term pregnancy. Here we have to give the approximately 100 mg of the elemental Iron and that too tackle the physiological anemia and if she develops anemia more than that automatically we have give a more Iron, more folic acid supplementation practically 5 mg per day to this lady and proteins supplementation has to be made practically doubled-up. The weight gain in this particular patient is not 9 or 10 kg, it is 15 to 16 kg. One-and-half times more so automatically all needs of the patient they increase. Her caloric requirement they increased by 300 kilocalories. Normally, we advise the patient to take 2500. Here we have to ask the patient to take something like 2800 kilocalories and these are the people if they have anemia they have lot of complication. Twins are responsible for many problems, more spontaneous abortions more incidents of preeclampsia, more incidence of preterm labor, more incidence of premature rapture of membranes, more incidence of placenta previa so all these problems which are there. They will be exaggerated if the patient having superadded anemia so if you keep the hemoglobin of a multiple gestation patient more than 11 grams normally for a single term pregnancy I say more than 10 grams, yes it is okay, but here it has to be more than 11 grams if you avoid preterm labor, to avoid the premature rupture of membranes, to avoid the small birthrates of the baby. Lets make the twin pregnancy by supplying a right Iron at right time in right dose along with the protein and folic acid so that you can carry the twin pregnancy up to term very safely. I always say “Ek Se bhale do” and that is really true when two babies are the in uterus, when we are taking their proper care. So sir to reduce burden of anemia and thereby to reduce the morbidity and mortality what will be your key message for the practitioners when it comes to the twin pregnancy. Investigations to be done in a right time. Hemoglobin has to be done in the first trimester. Do it every 4 weekly so that you can come to know that when the patient is going to develop the anemia. For a normal pregnancy 3 times hemoglobin is sufficient. Here I advise let the hemoglobin should be done every monthly interval so that you can come to know minimum hemoglobin, PCV, and peripheral blood smear. You come to know the anemia as early as possible, detect early, treat early and avoid the complication. Twin pregnancy is a good pregnancy provided we are taking good care of the patient. Thank you so much sir for informative discussion and throwing the light on management of the twin pregnancy and the role of Iron and Folic acid in reducing the burden of anemia. Thank you so much. Thank you doctor

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