A major obstacle to human health as well as the advancement of social and economic conditions, anaemia is a severe nutritional issue that affects millions of people in developing nations. A patient with anaemia has inadequate red blood cells and their ability to carry oxygen to fulfil their body's demands, which might vary depending on factors including age, sex, altitude, smoking, and pregnancy status.(Source: )

While there are other illnesses that can cause anaemia, including folate, vitamin B12 and vitamin A deficiencies, chronic inflammation, parasite infections, and hereditary abnormalities, iron deficiency is regarded to be the most prevalent cause of anaemia worldwide.Fatigue, weakness, vertigo, and sleepiness are linked to its severe form. Particularly vulnerable are children and pregnant women

Pregnancy-related anaemia is defined by the WHO as haemoglobin levels less than 11 grammes. dl. Additional anaemia classifications are used by the Indian Council of Medical Research (ICMR) based on haemoglobin level. [1] It is believed that 40% of people worldwide suffer from anaemia. Approximately 50% of all anaemic women worldwide reside on the Indian subcontinent. Because of a diet low in iron, between 50 and 80 percent of Indian women get anaemia. anaemia in mothers always results in anaemia in newborns and new mothers. Maternal anaemia and malnutrition cause low birth weight in around 30–40% of newborns.[2]

Anaemia in the postpartum period is defined by the WHO as haemoglobin levels <11g% (110 g/dl) at one week and <12g% (120 g/dl) at eight weeks. Prepartum anaemia along with acute bleeding anaemia from blood losses after birth are the main causes of postpartum anaemia. The average amount of blood lost after childbirth is about 300 millilitres, although 5-6% of women experience haemorrhages exceeding 500 millilitres. After a normal birth, 1 week postpartum, the prevalence of anaemia (haemoglobin <110 g/L) in healthy women is 14% in those who take iron supplements and 24% in those who do not. 48 hours after birth, anaemia is prevalent in around 50% of European women in successive series. The incidence of postpartum anaemia in underdeveloped nations is between 50% and 80%.[3]

A mother's and her child's long-term health might be affected by iron deficiency anaemia during the postpartum phase. Mothers who have insufficient iron levels at the time of birth may suffer from exhaustion, decreased cognitive function, and depressed symptoms. These symptoms may significantly effect the infant's behaviour and development, as well as the mother's relationships with the baby. In areas where anaemia is common, among women who consume low-bioavailable iron diets and have short inter-pregnancy intervals (less than 18 months), the negative effects of postpartum iron deficiency and anaemia may persist into other stages of the reproductive cycle if iron stores

not restored soon after childbirth. This can result in continued adverse outcomes for both mothers and infants. [4] Following childbirth Anaemia is linked to worse life quality, poorer breastfeeding, poor wound healing from LSCS, diminished cognitive function, emotional instability, and depression.

This two-year study, which took place at the Obstetrics and Gynaecology department of the MKCG Medical College ,Berhampur between September 2020 and August 2022, was a prospective study centred in a tertiary care institution. After properly signing an informed consent form, all patients were enrolled. Upon doing a thorough history, clinical examination, and limited tests, alternative explanations of anaemia were excluded. The woman's initial iron status was determined by clinical and laboratory testing, including serum ferritin levels and a full blood picture. Based on inclusion and exclusion criteria, a total of 100 postpartum women who had acquired postpartum IDA (with serum ferritin levels less than 15 µg/ml and Hb levels between 7-9 gm/dl at 24-48 hours post-delivery) were included in the research. Every woman in the 100 had a unique serial number

INCLUSION CRITERIA :-

All post partum women in the first week with Hb between 7-11 g/dl are to be selected who would be given oral preparation or intravenous iron as per suitability.

EXCLUSION CRITERIA:-

1. Women with history of anemia other than Iron deficiency anemia were
2. On myelosuppresive
3. Recent blood transfusions (within 3 months).
4. Therapy with erythropoietin within 3 months prior to

CONSENT OF PATIENT:-

Consent for all cases have to taken before administering the drug, a detailed history taking and complete general examination and detailed obstetric examination.

Method

50 Patients in this group were given split doses of intravenous iron ferric carboxymaltose during the trial, which were repeated on different days as needed based on body weight and haemoglobin deficiency. Following the injection of the determined dosage, treatment was discontinued. Throughout the course of the treatment, patients were observed for any indications of adverse effects.

The aim and objective is to study the “comparision of efficacy of intravenous ferric carboxy maltose vs oral iron in the treatment of iron deficiency anemia in postpartum period ”in mothers admitted in IPD of O&G Department of MKCG during September 2020 to August 2022.

TABLE 1: AGE WISE DISTRIBUTION OF PATIENTS WITH ANAEMIA

Most of the patients were in age group 20-24 i.e 40% with reduced incidence i.e 36% in the age group of 25-29,11% in the age group ≥30 and13% in age group <2

TABLE 2: AGE WISE DISTRIBUTION OF POSTPARTUM ANAEMIC PATIENTS BASED ON ORAL IRON AND IRON FCM THERAPY GROUP

In the above table it may be seen that in the oral iron therapy group 4(8%) patients were under 20 years of age,19 (38%) were between 20-24 years,20(40%) patients were between 25-29 years of age and 7(14%) were above 30 years. In the iron FCM therapy group ,9(18%) were below 20 years,22(44%) were between 20-24 years,15(30%) were between 25-29 years and 4(8%) were above 30 years of age.

TABLE  3: DISTRIBUTION OF PATIENTS ACCORDING TO BMI

Most of the patients belong to normal BMI i.e 81 % while 14% underweight and 5% were over weight. TABLE 4: DISTRIBUTION OF  PATIENTS  ACCORDING  TO  BMI                                                                                                                         IN RELATION  TO THE TWO

MODALITIES OF TREATMENT

In table 4 : most of the patient were of normal BMI, in the oral iron therapy group 35(70%) and 46(92%) in the intravenous iron therapy group. In oral iron therapy group 10(20%) were under weight and 5(10%) were over weight.In intravenous iron FCM therapy group 4 (8%) were under weight.

TABLE 5: DISTRIBUTION OF PATIENTS ACCORDING TO PARITY

Above table shows most of the patients were multipara 59% and rest 41 % were primipara, In oral group, 23 patients i.e 46% were primipara and 27 patient i.e 54% were multipara. In injectable iron CM group, 18 patients i.e 36% were primipara and 32 patients i.e.64% were multipara.

Postpartum anaemia may be linked to a higher incidence of dyspnea, exhaustion, palpitations, and infections in women, especially urinary tract infections. These symptoms may make it difficult for mothers to care for their children and may affect the mother-child relationship emotionally.It is critical to treat postpartum anaemia in order to improve quality of life, reduce the risk of anaemia during subsequent pregnancies, and replenish iron stores in purpura. In order to determine if administering iron by IV in the form of iron FCM to women suffering from postpartum anaemia leads to increased haemoglobin concentrations and better iron reserves as opposed to oral iron therapy, the following study was conducted.

Anaemia was detected more frequently in the group of 20–24 years old, or 40%, and less frequently in the group of 20–30 years old, or 11%, in this study table no. 1 during the first screening and recruitment of postpartum patients in the delivery room and ward based on inclusion and exclusion criteria. The results of this study are consistent with those reported in The International Journal of Science and Research in 2013, which found that the age range of 20 to 24 had the greatest prevalence of anaemia. Gautam VP et al. (2002) and Nesimi et al. (2005) reported similar outcomes. Anaemia was more prevalent in the 25–29 age range in the table no. 2 comparing the two treatment modalities, with 40% in the oral iron therapy group and 44% in the other group.

In the intravenous FCM iron treatment group (20–24 years of age). According to the current study's table no. 3, anaemia was more common among patients with a BMI between 18.5 and 24.99, or 81% of patients who were underweight and 5% of patients who were overweight. Anaemia was less common in women with overweight/obesity or central obesity as compared to normal weight women, according to similar findings from a 2013 study by Manal Ibhrahim and Ayat Abdallah comparing the BMI and anaemia in Arabic women. the lowest frequency of anaemia among overweight women and a much greater prevalence in underweight and normal weight women, according to the findings of a study done in 2014 in West Bengal by Amitava Pal. This was connected to inadequate nutrition and unsatisfactory eating habits. Table 4 compares the two groups and reveals that anaemia was more common in individuals with normal BMIs (70% in the oral iron therapy group and 92% in the FCM iron therapy group).

In the current investigation [Table no. 5]. Anaemia was seen in 59% of the 100 patients who were multipara and 41% of the patients who were primipara.Ayesha Farooq did a research in Islamabad in 2011, and the results were comparable to those of a study by Bodnar in the USA and Yahya Mal Farsi and Daniel R Brooks, which revealed that roughly 72% of multiparous individuals had iron insufficiency with serum ferritin < 20 µg/ml.As a result of the stress of several pregnancies, multiparous women have insufficient iron levels.

A child's birth should be a happy occasion.On the other hand, unanticipated health issues such postpartum anaemia may arise and complicate this period. Postpartum anaemia can result from birth circumstances and physiological repercussions. Anaemia during the postpartum period is a prevalent health issue; nevertheless, there is a dearth of research on this topic.Preventing and treating anaemia during the postpartum period is crucial for lowering mother mortality and morbidity, enhancing life quality, and strengthening the link between mother andchild.

The current investigation concentrated on the incidence of anaemia in recent mothers and the efficient treatment of this condition using quick and secure methods. The current study demonstrates that postpartum haemoglobin levels respond favourably to intravenous iron ferric carboxymaltose supplementation. The haemoglobin level in the group receiving iron supplements tended to rise in comparison to the baseline values.For postnatal women with iron deficiency anaemia, intravenous iron treatment delivery raises the haemoglobin level more quickly than oral iron consumption.

Additionally, compared to oral iron, intravenous iron treatment replaces iron reserves more quickly.In the postpartum period, it can be used as a safe and efficient substitute for oral iron therapy and blood transfusions for the treatment of iron deficient anaemia. While the injectable iron group can guarantee compliance, the expense of injectable iron is higher than that of iron tablets. The study's recommended restricted dose schedule of iron ferric carboxymaltose is a safe and efficient substitute for daily oral iron supplementation in the treatment of postpartum anaemia, provided that cost is not a barrier.

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