Changes in the Blood Picture in Pregnancy, Deli­very, and Puerperium, Particulary Centering Around the Blood Loss During Delivery

For the periods ranging from the fifth gravid month to the sixth post partum week continuous examinations were conducted on the blood picture of 10 multiparas and 18 primipars who came to the Second Maternity Hospita, Okayama University Medical School, from December 1955 to December 1956, and all those who had no complications throughout pregnancy, delivery and puerperium. In addition observations were carried on the 245 subjects who had no complibation throught pregnancy, delivery and puerperium to see what influences the blood loss during delivery might exert on blood picture during puerperium, particularly the changes of hemoglobin concentration (Hb), and the author arrived at the following conclusions: 1) By the continuous examinations of pregnat women the existence has been recognized of physiological anemia which recovers close to the level of healthy non-pregnant women within one month after delivery. Namely, it has been found that already by the fifth month of pregnancy a considerable decrease both in erythrocyte counts and Hb values is recognized as compared with those of healthy non-pregnant women (the control), but starting around the eighth month the values of both keep on increasing month after month until reaching their maximum at delivery yet still a little below those of the control, and particularly Hb values as compared with those of the control show a significant fall. During puerperium erythrocyte counts and Hb values recover rapidly and by the sixth post partum week they reach close to the level of the control. 2) By the latter part of pregnancy both in multipara and primipara Hb values shew a marked decrease as compared with erythroyte count. Gradually presenting hypochromic-anemia picture, even in the sixth post partum week a delay in the recovery of Hb values can still be recognized, the delay being particularly striking in primipara. 3) It has been noticed that there is a greater tendency of delay in the recovery of Hb values along with increase in blood loss during delivery. Namely, though in the groups with blood loss of less than 10g./kg. at delivery the recovery of Hb values during puerperium is smooth and hematopoietic functions seem to be undisturbed. However, with increase in blood loss the recovery is proportionately delayed and in the groups with over 12.5 g./kg. loss a marked delay in the recovery of Hb has been recognized. 4) In primipara groups with under 7.5g./kg. blood loss and in multipara with under 12.5 g./kg. loss, the recovery of Hb values during puerperium is smooth; but in primipara with blood loss of over 10 g./kg. and in multipara with the loss of over 15 g./kg. the delay has been quite marked. In other words, in the groups with blood loss of over 7.5 g./kg. the rate of recovery in Hb values tends to be faster in multipara than in primipara. 5) Along with increase in the frequency of labor, the rates of increase have tended to increase by degrees.