Published: 2021-05-27

Study of antepartum hemorrhage and its maternal and perinatal outcome at a tertiary care hospital

Amruta R. Kulkarni, Arti S. Shirsath


Background: Antepartum haemorrhages are defined as bleeding from or into the genital tract after the period of viability untill delivery of the fetus. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Objective of this study is to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care hospital.

Methods: A retrospective observational study was carried out in the department of obstetrics and gynecology, Smt. Kashibai Navale medical college and general hospital, Pune. Patient information was obtained from the delivery records of 2018, 2019 and 2020. Patients presenting after the gestational age of 28 weeks with antepartum haemorrhage were included in the study.

Results: Out of 100 cases of APH, abruptio placenta contributes to 60%, placenta previa to 37% and 3 cases were due to unknown cause. Overall maternal mortality was 3% and perinatal mortality was 23% in abruptio placentas compared to 13% in cases with placenta previa. Main cause of perinatal mortality was prematurity69%.

Conclusions: Antepartum haemorrhage is one of the leading cause of perinatal mortality and morbidity. These cases should be deliverd at a centre with transfusion facility, NICU facility and by the obstetrician skilled in controlling intraoperative haemorrhage by stepwise devascularising sutures. Timely decision of uterine tamponade can also save few ceaserean hysterectomies.


APH, Abruptio placentae, Placenta previa

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Bhide A, Thilaganathan B. Recent advances in the management of placenta previa. Curr Opin Obstet Gynecol. 2004;16(6):447-51.

Calleja-Agius J, Custo R, Brincat MP, Calleja N. Placental abruption and placenta praevia. Eur Clin Obstet Gynaecol. 2006;2:121-7.

David AM. Treatment of antepartum haemorrhage. Womens and children’s Hospital. Available at: Accessed on 20 January 2021.

Antepartum Haemorrhage (Green-top Guideline No. 63). Royal College of Obstetricians and amp; Gynaecologists. Available at: uk/en/guidelines-research-services/guidelines/gtg63/. Accessed on 20 January 2021.

Sheiner E, Shoham-Vardi I, Hallak M, Hershkowitz R, Katz M, Mazor M. Placenta previa: obstetric risk factors and pregnancy outcome. J Matern Fetal Med. 2001;10(6):414-9.

Takai IU, Sayyadi BM, Galadanci HS. Antepartum hemorrhage: A retrospective analysis from a northern Nigerian teaching hospital. Int J App Basic Med Res. 2017;7:112-6.

Ikechebelu JI, Onwusulu DN. Placenta praevia: Review of clinical presentation and management in a Nigerian teaching hospital. Niger J Med. 2007;16:61-4.

Adekanle DA, Adeyemi AS, Fadero FF. Antepartum haemorrhage and pregnancy outcome in Lautech teaching Hospital, Southwestern Nigeria. J Med Sci. 2011:1243-7.

Tyagi P, Yadav N, Sinha P, Gupta U. Study of antepartum haemorrhage and its maternal and perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2016;5:3972-7.

Das B Antepartum haemorrhage in three decades. J Obstet Gynaecol India. 1978;25:636-7.

Maurya A, Arya S. Study of antepartum haemorrhage and its maternal and perinatal outcome. Int J Sci Res Publ. 2014;54:85-9.

Khouri JA, Sultan MG Previous Caesarean section and the rising incidence of Placenta previa and Placenta accrete. J Obstet Gynecol. 1994;14(1):14-6.

Hurd WW, Miodovnik M, Hertzberg V, Lavin JP Selective management of Abruptio placenta: A prospective study. Obstet Gynecol. 1983;61(4):467-533.

Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP First birth caesarean and placental abruption or previa at second birth. J Obstet Gynecol. 2001;97(5): 765-9.

Bhandiwad A, Bhandiwad AA. A Study of maternal and fetal outcomes in antepartum haemorrhage. J Evid based Med Healthcare. 2014;1(6):406-27.

Samal SK, Rathod S, Rani R, Ghose S. Maternal and perinatal outcomes in cases of antepartum haemorrhage: a 3-year observational study in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6:1025-29.

Nasreen F. Incidence, Causes and outcome of placenta previa. J Postgrad Med Inst. 2011;12:58-62.

Arora R, Devi U, Majumdar R. Perinatal morbidity and mortality in Antepartum haemorrhage. J Obstet Gynecol India. 2001;51(30):102-4.

Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol. 1980;137(6):687-95.