scholarly journals Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Nkosinathi Joyisa ◽  
Dhayendre Moodley ◽  
Thandeka Nkosi ◽  
Raesetja Talakgale ◽  
Motshedisi Sebitloane ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
South African ◽  
Vaginal Discharge ◽  
Unprotected Sex ◽  
Cross Sectional ◽  
Predictive Values ◽  
Vaginal Ph ◽  
Abnormal Vaginal Discharge ◽  
In Pregnancy

Background. High rates of bacterial vaginosis (BV) have been described in nonpregnant South African women. Studies of BV in South African pregnant women are sparse. Diagnosis and prompt treatment of BV in pregnancy are expected to have a positive impact on pregnancy outcomes and HIV prevention. This study was undertaken to determine the prevalence of BV in pregnant women in a high HIV burden periurban setting in KwaZulu-Natal and explore how to enhance BV diagnosis in this setting where syndromic management of sexually transmitted diseases is the standard of care.Methods. In this cross-sectional study, consenting HIV uninfected pregnant women were examined for abnormal vaginal discharge; nurses determined the vaginal pH and collected a vaginal swab for Gram-stain and Nugent scoring.Findings. Among 750 HIV uninfected pregnant women, 280 (37.3%; 95%CI 33.9-40.9) tested positive for BV. Using a vaginal pH > 4.4, 65% of women with BV were correctly identified, while an abnormal vaginal discharge correctly identified a significantly lower proportion (52.9%) of women with BV (p=0.005). The sensitivity, specificity, and positive and negative predictive values of vaginal pH testing were 65.9% (95%CI 60.0 – 71.5%), 61.4% (95%CI 56.8 – 65.9%), and 50.1% and 75.4%, respectively. The 20-24 year-old pregnant women were twice more likely to test positive for BV than the adolescent pregnant women (43.6% vs 21.1%) (p = 0.037) and BV was not associated with the duration of a sexual relationship, frequency of unprotected sex during pregnancy, number of lifetime sex partners, or the partner’s age.Conclusion. There is a high burden of primarily asymptomatic BV in HIV uninfected pregnant women in this periurban setting. Both the sensitivity and specificity of vaginal pH testing are superior to the symptomatic diagnosis of BV but not good enough to be used as a screening tool.

scholarly journals Cytological and cultural evaluation of abnormal vaginal discharge in pregnancy and its co-relation with maternal and neonatal outcome

2020 ◽  
Vol 9 (2) ◽  
pp. 755
Author(s):  
Vaibhav Suresh Khairnar ◽  
Manjushri Ravi Waikar
Keyword(s):  
Pregnant Women ◽  
Vaginal Discharge ◽  
Neonatal Outcome ◽  
Specific Treatment ◽  
Vaginal Swab ◽  
Vaginal Infections ◽  
Medical College ◽  
Abnormal Vaginal Discharge ◽  
Epidemiological Characteristics ◽  
In Pregnancy

Background: Pregnancy represents a risk factor in the occurrence of vaginal infection. This study was undertaken to define the persistence of vaginal flora in 280 pregnant women at 14 to 34 weeks' gestation and to evaluate the role of cytology in diagnosis of vaginal infections. It aims to study the maternal and neonatal outcome in pregnancy with vaginal discharge.Methods: High vaginal swab samples and data on epidemiological characteristics were collected from 280 pregnant women between 14-34 weeks with complaints of abnormal vaginal discharge at booking clinic of Indira Gandhi Government Medical College, Nagpur. Vaginal swab was collected and sent to laboratory for further investigation to establish etiological diagnosis. After diagnosis by vaginal swab report, subjects were treated with the specific treatment to individual infection. Subjects were followed up during antenatal period for complications. A birth weight of delivered baby was noted. The data was analysed using software Graph Pad in stat 3.Results: The incidence of abnormal vaginal discharge in pregnancy was 23.9% in one year. The frequency of abnormal discharge was 53% among those aged 20-24 years (97/183), 49.2% in primigravida (65/132). Pain in lower abdomen and back was the most common symptoms i.e. 88.19% in Cases, while 17.36% had vulval pruritus and 14.58% had dysuria.Conclusions: This study recommend that women complaining of vaginal discharge in pregnancy should be evaluated for infections. this study supports CDC-P recommendation as all women who have symptomatic vaginitis, should be treated regardless of pregnancy status.

scholarly journals MICROBIOLOGICAL PROFILE OF VAGINOSIS AMONG WOMEN OF THE REPRODUCTIVE AGE GROUP, WHO ATTENDED AT DMC, LAHERIASARAI, BIHAR

2020 ◽  
pp. 82-85
Author(s):  
Neha Jha ◽  
R. S. Prasad ◽  
P. N. Jha ◽  
Debarshi Jana
Keyword(s):  
Bacterial Vaginosis ◽  
Vaginal Discharge ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Yeast Cells ◽  
Age Group ◽  
Vaginal Infections ◽  
Cross Sectional ◽  
Abnormal Vaginal Discharge ◽  
Reproductive Age Group

Background: An abnormal vaginal discharge is a common complaint in women and it can be due to vaginal infections like bacterial vaginosis, candidiasis and trichomoniasis. Aim: A descriptive cross sectional study was done at Microbiology Department, DMC, Laheriasarai, Bihar to find out the common pathogens which caused vaginosis in patients of the reproductive age group, who attended the Obstetrics and Gynaecology Department at the Darbhanga Medical College and Hospital, Laheriasarai, Bihar and referred to Microbiology Department of DMC, from 1st April to 30th September, 2020. Materials and Methods: All the 140 vaginal discharge samples were subjected to gram staining to view the morphological nature of the bacteria which caused bacterial vaginosis and gram positive, budding yeast cells, wet film for the motility of Trichomonas and Chlamydial antigen detection by ELISA. Results: The overall positivity was 44%, which included bacterial vaginosis (36.4%). The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%. Conclusion: Bacterial vaginosis was found to be the commonest cause of the abnormal vaginal discharge in women of the reproductive age group.

scholarly journals Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women

2021 ◽  
Vol 43 (08) ◽  
pp. 600-607
Author(s):  
Angélica Melo ◽  
Ximena Ossa ◽  
Giselle Fetis ◽  
Lorena Lazo ◽  
Luis Bustos ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Clinical Diagnosis ◽  
Trichomonas Vaginalis ◽  
Vaginal Discharge ◽  
Signs And Symptoms ◽  
Laboratory Diagnosis ◽  
Cross Sectional Study ◽  
Vaginal Microbiota ◽  
Cross Sectional ◽  
Abnormal Vaginal Discharge

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women > 18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p = 0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa = 0.21; p = 0.003) and candidiasis (Kappa = 0.22; p = 0.001), and slight for trichomoniasis (Kappa = 0.14; p = 0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

scholarly journals Common microbial aetiology of abnormal vaginal discharge among sexually active women in Dhaka, Bangladesh

2013 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Md Abdullah Yusuf ◽  
Mahmuda Chowdhury ◽  
KM Shahidul Islam ◽  
Eliza Omar Eva ◽  
Ahmad Raihan Sharif ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Trichomonas Vaginalis ◽  
Vaginal Discharge ◽  
Age Groups ◽  
Vaginal Candidiasis ◽  
Common Symptom ◽  
Sexually Active ◽  
Age Group ◽  
Cross Sectional ◽  
Abnormal Vaginal Discharge

Abnormal vaginal discharge is a common symptom of genital infection in women. The aim of the present study was to evaluate the various causes of vaginal discharge in sexually active females. A cross-sectional study was undertaken among women aged 15 to 45 years with abnormal vaginal discharge, with or without itching attended at Sir Salimullah Medical College, Dhaka for a period of 6 months. After making the clinical diagnosis, appropriate tests for diagnosing candidiasis, trichomoniasis, gonorrhea and bacterial vaginosis were done. Among all patients, organisms responsible for abnormal vaginal discharges were found in 94.8% of the cases, of which vaginal candidiasis (53.6%) was the most common, followed by bacterial vaginosis (29.2%), trichomoniasis (10.8%), gonorrhea (1.2%) and non-specific other urogenital causes (5.2%). The most common age groups affected by vaginal candidiasis, bacterial vaginosis and trichomoniasis were 26-35 years (64.9%), 26-35 years (27.6%) and 15-25 years (52%) respectively. Gonorrhea was recorded in the age group of 15-25 years (66.7%). Most of the organisms were isolated in the age group of 30-40 years. The causative agent of vaginal candidiasis was the leading cause of vaginal discharge in the age group of sexually active women and next to it was the bacterial vaginosis. A lower rate of Trichomonas vaginalis was found in our study in comparison to other studies. DOI: http://dx.doi.org/10.3329/seajph.v1i1.13211 South East Asia Journal of Public Health 2011:1:35-39

Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Geographic Location ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

scholarly journals 31. Influenza Vaccination During Pregnancy: A Descriptive Cross-sectional Survey of the Knowledge, Beliefs, and Attitudes of Mexican Gynecologists and Family Physicians

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
Erika Z Lopatynsky-Reyes ◽  
Sue Ann Costa-Clemens ◽  
Enrique Chacon-Cruz ◽  
Michael Greenberg
Keyword(s):  
Influenza Vaccination ◽  
Pregnant Women ◽  
Latin American ◽  
Vaccine Coverage ◽  
Family Physicians ◽  
Morbidity And Mortality ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Beliefs And Attitudes ◽  
In Pregnancy

Abstract Background Influenza in pregnancy is associated with elevated morbidity and mortality. Influenza vaccines are both safe and effective in pregnancy, supporting routine use in this population. Even though influenza vaccination in Mexico is recommended for pregnant women, there are no publications of influenza vaccine coverage in pregnancy. This is the first Latin American survey done only in physicians aiming to assess the knowledge, beliefs, and attitudes that Mexican Obstetrics-Gynecologists (OBG) and Family Physicians (FP) have towards influenza and influenza immunization during pregnancy. Methods A cross-sectional survey was conducted, both paper-based and online. The questionnaire was composed of 35 questions, which addressed general knowledge of influenza, recommendations for vaccination during pregnancy, and beliefs and attitudes concerning the acceptability of the vaccine in pregnant women. Results A total of 206 completed surveys were available, 98 (47.6%) from OBG, 108 (52.4%) from FP. Regarding current practicing medical institutions, 76 (37%), 69 (34%), 31 (14.5%), 30 (14.5%) reported working for the Mexican Institute of Social Security, Private Sector, Secretariat of Health, or a combination of all respectively, representing an estimated 2,472 daily pregnancy consultations. About a quarter (26.2%) reported not having a notion that influenza is more severe among pregnant women. More than half (51.5%) ignored the potential side effects of influenza infection on the fetus. The majority (56.8%) did not know when vaccination during pregnancy should occur. Pregnancy as a risk factor for developing influenza complications was known only in 48.1%. Also, 46.1 % believed that vaccination only confers protection to the mother, but not to the fetus. Nevertheless, 96.1% considered that immunization against influenza during pregnancy is a safe and effective preventive intervention. A results’ summary is shown in Figure-1. Conclusion Based on this survey, current knowledge of OBG and FP for influenza morbidity and mortality during pregnancy, and the importance of influenza vaccination in pregnant women, is poor. Mandatory recommendations to educate medical providers regarding influenza vaccination during pregnancy in Mexico are necessary, even as imperative for CME credits. Disclosures All Authors: No reported disclosures

The Effect of Counselling Intervention during Antenatal Care on the Knowledge and Attitude about Danger Signs in Pregnancy: A Cross-Sectional Study in Takalar Regency -

2020 ◽  
Vol 10 (2) ◽  
pp. 51-55
Author(s):  
Nurhikmah ◽  
Tahir Abdullah ◽  
Stang ◽  
Suriah ◽  
Andi Imam Arundhana ◽  
...  
Keyword(s):  
Health Service ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Community Health ◽  
Health Workers ◽  
Community Health Service ◽  
Cross Sectional ◽  
Danger Signs ◽  
Knowledge And Attitude ◽  
In Pregnancy

Objective: This study was to examine the effects of counselling delivered during antenatal care on the knowledge and attitudes of pregnant women about danger signs in pregnancy.Methods: This was a pre-experimental design using one group pre- and post-test only. This study was conducted in Takalar, specifically within Sanrobone Community Health Service working area. Takalar is located in South Sulawesi Province Indonesia and this area is coastal with the majority of people working as a fisherman. Participants of this study were pregnant women living in the villages which are included in the working area of Sanrobone Community Health Service.Results: The study shows that counselling improved knowledge and attitude of pregnant women about danger signs in pregnancy (p=0.011 and p=0.025, respectively). The number of pregnant women with good knowledge and positive attitude increased after the intervention (43.8% vs 93.8%, 62.5% vs 93.8%, respectively).Conclusions: In can be concluded that intervention by means of counselling can improve the knowledge and attitude of pregnant women about danger signs in pregnancy. Therefore, it is important to implement the counselling program delivered by health workers in Community Health Service in order to mitigate the risk of maternal mortality.

scholarly journals Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude

Nutrients ◽  
2018 ◽  
Vol 10 (7) ◽  
pp. 916 ◽  
Author(s):  
Andrea Hemmingway ◽  
Karen O’Callaghan ◽  
Áine Hennessy ◽  
George Hull ◽  
Kevin Cashman ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Pregnant Women ◽  
Calcium Intake ◽  
Geometric Mean ◽  
Vitamin D Status ◽  
Metabolic System ◽  
Cross Sectional ◽  
The Mean ◽  
In Pregnancy

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks’ gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = −0.311, p < 0.001), but not with calcium intake or serum calcium (r = −0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800–1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.

scholarly journals Cross-sectional study to assess etiology and associated factors for anaemia during first trimester of pregnancy in Anuradhapura District, Sri Lanka: a protocol

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 223
Author(s):  
Gayani Amarasinghe ◽  
Vasana Mendis ◽  
Thilini Agampodi
Keyword(s):  
Sri Lanka ◽  
Data Collection ◽  
Pregnant Women ◽  
Associated Factors ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Background: Anaemia in pregnancy, which can lead to adverse maternal and fetal outcomes, is a significant global health problem. Despite Sri Lanka’s strong public health system and commitment towards prevention, maternal anaemia remains a major problem in the country. While prevention is focused on iron deficiency, detailed etiological studies on this topic are scarce. Moreover, estimates of socio demographic and economic factors associated with anaemia in pregnancy, which can provide important clues for anaemia control, are also lacking. This study aims to evaluate the hemoglobin distribution, spatial distribution, etiology and associated factors for anaemia in pregnant women in Anuradhapura, Sri Lanka. Methods: This is a cross sectional study of pregnant women in their first trimester registered for antenatal care from July to September 2019 in the Anuradhapura district. The minimal sample size was calculated to be 1866. Initial data collection has already been carried out in special field clinics for pregnant women between June to October 2019. An interviewer-administered questionnaire, a self-completed dietary questionnaire and an examination checklist were used for data collection. In addition, all participants underwent complete blood count testing. Further investigations are being conducted for predicting the etiology of anaemia based on a developed algorithm (such as high-performance liquid chromatography [HPLC] and peripheral blood film analysis). Discussion: Being the largest study on anaemia during pregnancy in a single geographical area in Sri Lanka, this study will provide important clues about geographical clustering of anaemia cases with similar etiology, associated factors and etiologies which would help to develop interventions to improve the health of pregnant women in the area. The possibility of selection bias is a potential limitation associated with the study design.

scholarly journals Gambaran Kadar Hemoglobin pada Ibu Hamil Trimester III di Rumah Sakit Robert Wolter Mongisidi Manado

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Selfesina Sikoway ◽  
Yanti Mewo ◽  
Youla Assa
Keyword(s):  
Pregnant Women ◽  
Descriptive Study ◽  
Hemoglobin Level ◽  
Inclusion Criteria ◽  
Third Trimester ◽  
Cross Sectional ◽  
Abnormal Phenomenon ◽  
Cross Sectional Design ◽  
Obstetric Department ◽  
In Pregnancy

Abstract: Hemoglobin (Hb) is a parameter used to determine anemia prevalence. The average level of normal Hb at the end of pregnancy is around 12.5 g/dL, meanwhile, aproximately 5% of pregnant women have Hb level less than 11.0 g/dL. To date, Hb level below 11.0 g/dL especially at the end of pregnancy should be considered as an abnormal phenomenon and is usually caused by iron deficiency and not by hypervolemia which is commonly found in pregnancy. This study was aimed to determine the hemoglobin level of third semester pregnant women in Robert Wolter Mongisidi Hospital Manado. This was a descriptive study with a cross sectional design. Subjects were 39 third semester pregnant women who visited the Obstetric Department of Robert Wolter Mongisidi Hospital and fulfilled the inclusion criteria. The results showed that 25 subjects (64.1%) had low hemoglobin levels and 14 subjects (35.9%) had normal level of hemoglobin. In conclusion, most third semester pregnant women had low hemoglobin levels.Keywords: hemoglobin rate, third trimester pregnant women, anemia Abstrak: Hemoglobin (Hb) darah merupakan parameter yang digunakan untuk menetapkan prevalensi anemia. Nilai normal Hb pada akhir kehamilan rata-rata 12,5 g/dL, dan sekitar 5% wanita hamil konsentrasinya kurang dari 11,0 g/dL. Nilai Hb dibawah 11,0 g/dL terutama pada akhir kehamilan perlu dianggap abnormal dan biasanya disebabkan oleh defisiensi besi dan bukan karena hipervolemia yang umumnya ditemukan pada kehamilan. Penelitian ini bertujuan untuk mengetahui kadar hemoglobin pada ibu hamil trimester III di Rumah Sakit Robert Wolter Mongisidi Manado. Jenis penelitian ialah deskriptif dengan menggunakan desain potong lintang. Subyek penelitian ialah 39 ibu hamil trimester III yang berkunjung di Poliklinik Kebidanan di Rumah Sakit Robert Wolter Mongisidi Manado yang memenuhi kriteria inklusi. Hasil penelitian menunjukkan 25 subyek (64,1%) memiliki kadar hemoglobin rendah dan 14 subyek (35,9%) memiliki kadar hemoglobin normal. Simpulan penelitian ini ialah sebagian besar ibu hamil trimester III memiliki kadar hemoglobin rendah.Kata kunci: kadar hemoglobin, ibu hamil trimester III, anemia

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