الفهرس 
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Abstract
Globally, postpartum hemorrhage is the most important single cause of maternal death, accounting for about 25% of deaths. 88% of these deaths occur within four hours of delivery, indicating the importance of events in the third stage of labor. Furthermore, a significant predisposing factor, anemia, has a high prevalence in developing countries, more than one half of women of childbearing age in Africa are anemic.
This prospective cohort study conducted at the Department of Obstetrics & Gynecology, El-Minia University Maternity Hospital during the period from 1st of March till 31st of August 2013.
All women attended to the antenatal care clinics during the study period were instructed to take non-stop twice daily oral iron tablets (Glucofer). Cases with hemoglobin level < 10.5 g/dl with gestational age between 30-35w received intravenous iron therapy to correct their hemoglobin level in the form of low molecular weight iron dextran “CosmoFer”.
Cases with hemoglobin level < 11 g/dl with gestational age 36w or more received packed RBCs until hemoglobin of 11g/d or more was reached. Hemoglobin level was checked on admission to labor ward and on weekly bases for follow up until delivery, using Drabkin’s method.
On hospital admission, 10 ml of venous blood withdrawn for hemoglobin and plasma nitrite estimation. All studied women were treated similarly by active management of labor. The 3rd stage of labor was actively managed observing for atonic postpartum hemorrhage applying graduated collecting bag underneath the buttock of parturient for blood loss collection estimation.
Women divided into 2 groups:
Group 1: with normal hemoglobin, 11 g/dl or more (280 women).
Group 2: hemoglobin less than 11g/dl (220 women).
Analysis of the study showed that oral iron therapy and good nutrition alone was effective in prevention and treatment of iron deficiency anemia in approximately 78.6 % of cases if a non-stop oral iron tablets were taken twice daily from 14 weeks of pregnancy till labor with good nutritional iron supplementation. In addition, Parentral iron therapy was helpful in treatment of iron deficiency anemia in 17.5% thus the need for packed RBCs transfusion were limited to 3.9 % only of cases.