29 The sensitivity of highly sensitive rapid diagnostic testing, conventional rapid diagnostic tests and light microscopy to detect malaria in peripheral blood samples in pregnant women in a low-transmission setting were 86%, 83% and 77%, respectively. ![]() Peripheral smears are frequently negative despite placental infection. In areas where malaria is endemic and pregnant women may have a high background level of immunity, infection is generally not associated with fever but may be associated with severe anemia. Diagnosis of malaria is based upon finding parasites on thick and thin blood smears, as well as malaria rapid diagnostic tests. Malaria is an important cause of severe anemia. In addition erythrocyte deformability is significantly lower with pre-eclampsia than in healthy third trimester pregnancies. 27Įrythrocyte deformability is decreased in the first trimester compared with non-pregnant controls, and declines further in the second and third trimester. Most individuals with HIV have an inadequate rise in serum EPO for a given degree of anemia. 25, 26 However, EPO levels are below predicted value for hematocrit in first and second trimesters, generally being in agreement with hematocrit values in third trimester and peripartum.Īnemia is a common finding in women with human immunodeficiency virus (HIV) infection particularly those with advanced disease or using antiretroviral agents such as zidovudine. Serum immunoreactive erythropoietin (EPO) levels remain unchanged with pre-conception values in first trimester, absolute values progressively rising approximately 2–4-fold during second and third trimesters. 22, 23 Iron deficiency anemia in late pregnancy is associated with abnormal neonatal auditory maturation. 18 Adverse fetal outcomes of maternal anemia include delayed growth and development, impaired psychomotor and mental development, increased risk of cognitive and behavior abnormalities, and increased perinatal and neonatal mortality. 21 Additional maternal effects with anemia in pregnancy include increased susceptibility to infection, increased likelihood of blood transfusion, and greater risk of postpartum depression. 14, 15, 16, 17, 18, 19, 20 Severe anemia is associated with increased risk of maternal death (aOR 2.36). Maternal anemia in pregnancy is associated with increased rates of preterm birth, low birth weight, placental abruption, pre-eclampsia and postpartum hemorrhage. Sample reference intervals for hematological assays in healthy pregnancy.Īctivated partial thromboplastin time (APTT) (s) 3 Red cell mass also returns to normal levels by 6 weeks postpartum. 1 Red blood cell mass does not increase until approximately 20 weeks' gestation, and increases approximately 30% above the non-pregnant state. Plasma volume starts to fall from the 6th postpartum day, reaching non-pregnant levels at 6 weeks postpartum. Plasma volume starts to increase from the 6th gestational week, being approximately 10% above pre-pregnancy levels in early second trimester, then rising rapidly reaching levels greater than 50% above pre-pregnancy levels by 26 weeks' gestation, then plateauing for the remainder of pregnancy. Healthy pregnancy is associated with a fall in hemoglobin (Hb) and hematocrit due to the increase in plasma volume being greater than the increase in red cell mass, and occurring at an earlier gestation (Table 1). Wherever possible clinicians should use a reference interval specific to the laboratory that has performed the test. There is significant variability between laboratories depending on the method of testing, the assay used and population factors. Physiological changes in pregnancy may result in significant changes in normal values for many hematology assays, and as such results may be misinterpreted as abnormal or mask a pathological state. ![]() Interpretation of laboratory investigations relies on reference intervals. See end of chapter for details INTRODUCTION By completing 4 multiple-choice questions (randomly selected) after studying this chapter readers can qualify for Continuing Professional Development awards from FIGO plus a Study Completion Certificate from GLOWM
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