Diagnosis and Therapy of Anaemia in Pregnancy and Puerperium - A Survey of Obstetric Clinics in Switzerland

Purpose: Iron-deficiency anaemia is one of the main causes of increased fetomaternal morbidity and mortality. Our aim was to assess the diagnostic and therapeutic routines for iron-deficiency anaemia in obstetrics in Switzerland. Methods: A cross-sectional study was done using a highly standardized questionnaire to survey 64 obstetric hospitals in Switzerland. Results: The response rate was similar to 90%. The survey revealed a high variation (5-30%) in the estimates of the prevalence of this disorder. To initiate oral or intravenous iron substitution, the physicians use various cut-off values, resulting in both under-and over-supply. About half of the physicians reported a successful therapy for more than 70% of their patients, 20% even reported a success rate of more than 90% after therapy. However, about 10% of the physicians reported a success rate of less than 50% after therapy. Most hospitals (84%) use internal guidelines for the diagnosis and therapy of iron-deficiency anaemia. Nevertheless, most physicians (88%) would support the development and implementation of an evidence-based national guideline. Conclusions: We present a first nationwide survey of the diagnosis and treatment of iron-deficiency anaemia in pregnancy and puerperium in a European country. The results reveal a high variation in the various diagnostic and therapeutic procedures and underline the need to develop a uniform standard for the management of anaemia in pregnancy. Almost all Swiss obstetricians also expressed a keen interest in such a standard. In 2007, such a uniform standard was established by an Expertenbrief of the Schweizer Gesellschaft fur Gynakologie und Geburtshilfe entitled "Diagnostik und Therapie der Eisenmangelanamie in der Schwangerschaft und postpartal".