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Investigation of Anaemia at the Ante-natal Clinic, Church Road, Highgate
About 140 new cases are registered every year at this clinic; they are
drawn from a wide cross-section of the population and the five social
classes of the Registrar General are represented more or less equally.
They also include women of many nationalities i.e., Irish, Jamaican,
African, Swedish, German, French, Italian, Greek, Polish and American.
A medical officer of the Department, Dr. H. Gunn, reports that the
estimation of haemoglobin levels in expectant mothers has been carried
out at this clinic since 1953. For the first few months the Tallquist
Haemoglobin Scale was used but this was later abandoned for the Sahli
Haemoglobinometer which was found to be more accurate and easier
to read in artificial light.
At their first visit to the ante-natal clinic, all patients who are to be
confined at home or in the Alexandra Maternity Home have samples of
blood taken for determination of Blood Group, Rh Factor and Haemoglobin.
Approximately 86% of these women make their first visit at or
before the 18th week of pregnancy. Of the remaining 14% the majority
are seen before the 28th week but there are a few who make their first
visit much later either because they have recently moved into the district
or because they have neglected to make any arrangements for their
confinement or ante-natal care. In almost all of these cases, the Hb has
not been determined previously and their figures are included with the
"first visit" estimations given overleaf.
Although some authorities are concerned that the so-called "physio"
logical anaemia of pregnancy" is a true hypochromic anaemia and that
the Hb's of pregnant women can be maintained at or above 90%, with
adequate iron therapy, 80% has been taken as the dividing line in this
clinic.
To all women with Hb levels below 80% is given a month's supply of
Fersolate Tablets (1 T.D.S.) and they are asked to collect further supplies
at each visit until they are told to discontinue. If they report severe
constipation, abdominal pains or vomiting as a result of taking the
tablets an alternative iron preparation is offered.
A second Hb estimation is made at the 34th week and treatment is
stopped if the Hb has reached 80%. It is not possible, however, to follow
up all the original cases as a number are lost owing to miscarriage, moving
out of the district or transfer to hospital clinics. Some of the results
obtained, after what should be adequate dosage with iron, are disappointing;
but on close questioning of these it has been found that the
tablets have been taken erratically or in very inadequate doses. Some
women give them up for weeks at a time or reduce the dose to one a day
because of various unpleasant symptoms said to have resulted from them.
Others admit that they often forget them "because they have to be kept
out of reach of the children and are put out of sight."
The results obtainable for the last three years are set out overleaf. These
readings were all obtained at the first visit and although several of the
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