Federation of Obstetric and Gynecological Societies of India Consensus Recommendations for the Management of Postpartum Anemia with Specific Reference to Usage of Ferric Carboxymaltose

Abstract

Background: India has a substantially high burden of postpartum anemia (PPA). Several countries have guidelines regarding screening, diagnosis, and management of PPA. However, different modalities of treatment are followed in clinical practice, and consensus on management of PPA is lacking among the Indian practitioners. Aim: To review the current evidence and come to a consensus regarding definition, classification, appropriate time of screening and diagnosalong with management of PPA, with specific reference to usage of ferric carboxymaltose (FCM). Methodology: The core committee comprised of 11 obstetricians. Using the modified Delphi method, eight statements were created, discussed, and ranked by the obstetricians and recommendations were recorded. Statements were ranked on a 9-point Likert’s scale ranging from 1 (strongly disagree) to 9 (strongly agree). For each statement, the scores of all the obstetricians were summed and an average score of ≥7.00 was required to attain the consensus. Results: The cut-off hemoglobin (Hb) levels of above 11 gm/dL within 1-week postdelivery is termed as PPA. Postpartum anemia severity can be graded as mild, moderate, and severe with Hb levels of 10–10.9, 7–9.9, and below 7 gm/dL, respectively. All postpartum women (PPW) should be universally screened with Hb estimation and complete blood count (CBC) within 24–48 hours of delivery, prior to discharge, and repeat Hb estimation should be performed at 6 weeks postdelivery. Ferric carboxymaltose is superior to oral and other intravenous (IV) iron therapies and all PPW should be discharged with a single dose of FCM after an informed decision. Additionally, oral iron (OI) is not required during or following FCM administration, the decision to start oral therapy can be taken after 4 weeks of discharge, if required. Conclusion: Ferric carboxymaltose is a safe, effective, well-tolerated, and economical option for managing PPA and shall be practiced in awomen with PPA before discharge.