Q: My wife is in her 33rd week of pregnancy. She had a cerclage stitch done about 8 weeks back, as she had an opening of 0.7 mm. Subsequently her haemoglobin dropped to 7.4. She has had 2 units of packed cells given until yesterday. I am concerned as this is getting more complicated. What are the likely complications if any during childbirth and what is the possibility of normal childbirth?

A:The cervix is the lowest part of the uterus and extends into the vagina. When it is weak (cervical incompetence) there is likelihood of the baby being born prematurely because the cervix shortens or opens too early i.e. the cervix is at risk of opening under the pressure of the growing pregnancy. In order to prevent premature labour, a cerclage is placed in which the cervix is sewn closed during pregnancy. A closed cervix helps a developing baby stay inside the uterus until the mother reaches 37-38 weeks of pregnancy, when this stitch is removed. This procedure has nothing to do with anaemia. Anaemia is inadequate level of haemoglobin appropriate for age & sex. The most common cause of anaemia in pregnancy is deficiency of iron (~85% cases) and folic acid. Even if a woman is not anaemic at the time of pregnancy, she may still develop anaemia as the pregnancy progresses due to increased demands of the developing baby. There are certain risk factors for women being anaemic and these include: poor nutrition, inadequate gap between pregnancies, persistent nausea or vomiting in early pregnancy and twin pregnancy. The loss of iron (elemental) with each normal menses is around 12-15 mg. A normal diet must include 1.5-2 mg/day of elemental iron to compensate for menstrual losses alone. In pregnancy, 500 mg of additional iron is needed by the mother (to expand her red cell mass) while another 500 mg is needed for the baby and placental tissues. Thus, on an average, an additional 3 mg/day of elemental iron must be absorbed from dietary sources. The amount of iron absorbed by the body is only 10% of the total amount consumed, thus 30 mg/day needs to be consumed to meet the requirement. An iron deficient mother can have premature labour, intrauterine growth retardation (poor development of baby), severe anaemia due to normal blood loss during delivery and increased susceptibility to infection. The likelihood of postpartum transfusion may be reduced if a woman enters the birth with a higher haemoglobin level. You need to discuss with your doctor and she should be appropriately investigated and treated.