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O&G CasesAntenatal care — haematological disorders

O&G Cases · Antenatal care — haematological disorders

Late-presenting severe iron deficiency at 32 weeks — management station

Management station on iron deficiency anaemia presenting at 32 weeks after failed oral iron. Tests the FIGO indications for parenteral iron and transfusion, the ferric carboxymaltose trial evidence, communication with the patient, and the postpartum plan. Includes assessor key and marking domains.

resus3 min readSource-verified ·

Target exams

FRANZCOGMRCOGABOG
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Study tools

Target exams

FRANZCOGMRCOGABOG
Prompt
A 34-year-old G2P1 at 32 weeks gestation presents to the maternity assessment unit with exertional dyspnoea and palpitations for one week. She has been on oral ferrous sulfate 200 mg daily for four weeks but stopped because of constipation. Today her Hb is 76 g/L, MCV 71 fL, ferritin 5 micrograms per L. Observations: HR 102 bpm, BP 112/68 mmHg, RR 22, oxygen saturation 98 percent on room air. She is pale with a flow murmur. The fetus is well on cardiotocography.

Station brief

Format. Management station, approximately 12 minutes. You are the obstetric registrar on the maternity assessment unit. A midwife, an anaesthetist and a haematology registrar are available on call. The assessor will run the clock and feed you new information.

Candidate instruction. Lead the assessment and management of this woman. Verbalise your diagnosis, your drug orders with doses, your escalation triggers, and your communication with the patient.

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References7ShowHide
  1. [1]American College of Obstetricians and Gynecologists Anemia in Pregnancy: ACOG Practice Bulletin, Number 233 Obstet Gynecol, 2021.PMID 34293770
  2. [2]Khalafallah AA, Hyppa A, Chuang A, Hanna F, Wilson E, Kwok C, Yan C, Gray Z, Mathew R, Falloon P, Dennis A, Pavlov T, Allen JC A Prospective Randomised Controlled Trial of a Single Intravenous Infusion of Ferric Carboxymaltose vs Single Intravenous Iron Polymaltose or Daily Oral Ferrous Sulphate in the Treatment of Iron Deficiency Anaemia in Pregnancy Semin Hematol, 2018.PMID 30502851
  3. [3]Froessler B, Schubert KO, Palm P, Church R, Aboustate N, Kelly TL, Dekker GA, Hodyl NA Testing equivalence of two doses of intravenous iron to treat iron deficiency in pregnancy: A randomised controlled trial BJOG, 2023.PMID 36047598
  4. [4]Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, Tunçalp Ö, Torloni MR, Mittal S, Jayaratne K, Lumbiganon P, Togoobaatar G, Thangaratinam S, Khan KS Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis Lancet Glob Health, 2018.PMID 29571592
  5. [5]Rogozińska E, Daru J, Nicolaides M, Amezcua-Prieto C, Robinson S, Wang R, Godolphin PJ, Saborido CM, Zamora J, Khan KS, Thangaratinam S Iron preparations for women of reproductive age with iron deficiency anaemia in pregnancy (FRIDA): a systematic review and network meta-analysis Lancet Haematol, 2021.PMID 34171281
  6. [6]Camaschella C Iron deficiency Blood, 2019.PMID 30401704
  7. [7]Ubom AE, Begum F, Ramasauskaite D, Nieto-Calvache AJ, Oguttu M, Nunes I, Malel ZJ, Beyeza-Kashesya J, Wright A; FIGO Committee on Childbirth and Postpartum Hemorrhage FIGO good practice recommendations on anemia in pregnancy, to reduce the incidence and impact of postpartum hemorrhage (PPH) Int J Gynaecol Obstet, 2025.PMID 41031541
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