Prospective observational study was conducted to assessed anaemia and its complications across three obstetric and gynaecological patient groups – pregnancy (n = 61), abnormal uterine bleeding (AUB) (n = 28), and perioperative gynaecological patients (n = 38), at a tertiary care teaching hospital in Mysuru over six months. In the pregnancy cohort, the prevalence of anaemia increased from 34.4% at admission to 73.8% at post-partum and remained high at 70.5% at follow up. The remarkable post-partum increase in Indian obstetrics was due to a bad starting point. Bhushan et al. reported a high anaemia burden in pregnant and lactating women in a rural tribal community, associated with poor antenatal iron supplementation and dietary inadequacy. While Manna et al. found antenatal anaemia control remains suboptimal despite India’s anaemia Mukt Bharat program. The significant post-partum spike reflects intra-partum / post-partum blood loss rather than antenatal deficiency alone, since acute blood loss (50.8%) outranked iron deficiency anaemia (39.3%) as a primary aetiology. Among AUB patients, anaemia prevalence was significantly high (88.9%), with moderate anaemia predominating both at admission (63%) and post-operatively (74.1%), it consistent with Munro et al and FIGO committee description of AUB as a direct path to iron deficiency and anaemia. Microcytic hypochromic morphology (63%) and IDA as the leading aetiology (59.3), consistent with Munro et al. findings that chronic menstrual loss and iron depletion in reproductive-age women. The predominance of structural PALM-COEIN leiomyoma (22.2%) and adenomyosis (18.5%) with Goth Wal et al, identified leiomyoma as the leading pathology in AUB with surgical manged (hysterectomy) patients, Donnez et al, linked structural uterine disorders to sustained heavy bleeding and IDA. In the peri-operative cohort, anaemia prevalence increased from 39.5% (pre-operative) to 78.9% (post-operative), with moderate anaemia was most common category post-operatively. This is consistent with Khan et al. who reported worsening post-operative anaemia and rising complications among gynaecological and obstetrics surgical patients, and Abey Siri et al. identified peri-operative blood loss and inadequate pre-operative correction. There were strong positive correlations between pre- and post-operative haemoglobin (ρ = 0.751 in the AUB subgroup; ρ = 0.648 in the perioperative cohort, both p < 0.001), confirming baseline Hb as a major determinant of outcome, in line with the findings of Gunaydin et al. on the treatment of pre-operative anaemia. Neonatal outcomes include low birth weight (19.7%), respiratory distress syndrome (RDS) (16.4%), intrauterine growth restrictions (IUGR) (8.2%), and NICU admission (36.1%). Pre-treatment haemoglobin severity was significantly associated with NICU admission (χ² = 6.564, p = 0.0375), not with RDS, IUGR, birth weight or APGAR class. In consistent with Obeagu and Obeagu et al. linked maternal anaemia to adverse perinatal outcomes via chronic foetal hypoxia and impaired placental oxygen transfer. The lack of association between maternal Hb improvements and neonatal outcomes may reflect the short observation period. Breymann et al. who stress that antenatal IDA correction is needed to improve foetal outcomes. The significant link between blood transfusion and Hb improvement (χ² = 4.488, p = 0.0341) consistent with Ubom et al. FIGO recommendation that anaemia correction across pregnancy reduces post-partum haemorrhage and related maternal/neonatal morbidity. Emergency LSCS accounted for 68.9% of deliveries, likely reflecting the tertiary referral setting and high burden of anemia related complications necessitating operative delivery — consistent with Namutebi et al. who found postpartum hemorrhage as the leading postpartum complication (67.6%) in a Ugandan cohort, with inadequate early monitoring raising complication risk, reinforcing the value of vigilant peripartum Hb surveillance. In the AUB cohort, 48.1% had hysterectomy with BSO (advanced structural pathology: leiomyoma, adenomyosis). This is similar to Brazilian study by Rezende et al where structural causes were predominant and 47% had previous anemia and 6% required IV iron or transfusion, which is very close to this where 33.3% required transfusion and 66.7% required supplementation. These findings collectively support the FIGO view that AUB and iron-deficiency anemia share a yet-to-be-recognized clinical pathway until bleeding necessitates surgery. Iron/vitamin supplementation was given to most participants (83.6% pregnancy, 66.7% AUB, 65.8% perioperative), with transfusion reserved for more severe cases. Hemoglobin improved significantly across all three groups (paired t = 7.431, p < 0.001 pregnancy; Friedman χ² = 64.973, p < 0.001; paired t = 4.917, p < 0.001 perioperative), indicating broadly effective management — consistent with Saiyed and Suthar's Indian prescription-pattern data and Leung et al.'s stepwise oral-to-IV iron escalation is preferred by the Asian consensus. Notably, transfusion (rather than supplementation alone) demonstrated the strongest correlation with Hb improvement in the perioperative group (χ² = 19.487, p < 0.001). This is consistent with Shander et al.'s ICCAMS recommendations that oral iron is frequently insufficient for quick perioperative correction, necessitating transfusion or IV iron." Manna et al. noticed that there is a strong correlation between diet and post-treatment Hb severity (χ² = 14.006, p = 0.03), which emphasizes nutrition as a controllable factor. These findings echo the broader patient-blood-management literature: Surbek et al. and Leahy et al. both showed that structured anemia protocols combining early detection, iron optimization, and judicious transfusion improve outcomes and reduce unnecessary transfusion¹¹, ¹². The relatively low IV iron use observed here suggests scope for wider parenteral iron adoption, particularly in perioperative and AUB patients requiring rapid correction. The perioperative and AUB-surgical cohorts showed a consistent link between pre-operative anaemia and poorer post-operative haematological trajectory. Pre- and post-operative Hb were strongly correlated (ρ = 0.751 and 0.648, both p < 0.001), while greater improvement was tied to higher baseline Hb (ρ = 0.422, p = 0.008) but lower post-treatment Hb (ρ = −0.327, p = 0.045), reflecting regression toward severity in patients with lower reserve and greater blood loss. This aligns with Khan et al., who linked pre-operative anaemia to higher post-operative complications⁵, and Abey Siri et al. who identified it as an independent risk factor for morbidity and prolonged recovery¹³. The strong transfusion–Hb association (χ² = 19.487, p < 0.001) reflects reactive rather than pre-emptive management, echoing Shander et al.'s call for early screening¹⁴ and Gunaydin et al.'s findings favouring structured pre-operative correction¹⁵. Collectively, these findings support treating anaemia as a modifiable peri-operative risk factor rather than an incidental finding. Surbek et al. and Leahy et al. note that structured pre-operative anaemia pathways reduce transfusion needs and improve surgical outcomes¹¹, ¹². The near doubling of anaemia prevalence pre- to post-operatively at the study institution suggests earlier, systematic pre-operative correction could meaningfully reduce this burden.

Generate a presentation summarizing key findings across the three patient cohorts