DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20220572
Published: 2022-02-25

Feto-maternal outcome in cases of antepartum hemorrhageat a tertiary care hospital-a retrospective study

Puja Singh, Shubhra Agarwal, Rehana Najam

Abstract


Background: Antepartum haemorrhage (APH) is described as bleeding from or into the genital tract which occurs after 24 weeks of pregnancy and before prior to birth of infant. As per RCOG Guidelines in India, viable period is 28 weeks. APH is one of the leading causes of maternal mortality mostly in perinatal period worldwide and almost 3-5% of all the pregnancies are complicated because of it. Objectives of the study were to analyse incidence, risk factors of APH and to study the outcomes, the mode of delivery, perinatal mortality and also maternal mortality in APH.

Methods: A retrospective study conducted on patients who were admitted to TMMC and RC with complaints of bleeding per vagina after 28 weeks of pregnancy over a period of 1 year (December 2019-2020).

Results: A total of 100 patients with APH out of 1440 deliveries were noted which calculated the incidence to 6.9%. Out of all APH cases, the patients having placenta praevia made 65% of the total cases, abruptio placenta were 34% and undetermined cause was up to 1%. Out of majority of patients of APH, almost 62% were emergency cases. The incidence calculated for un-booked cases was far more. 15 patients having placenta praevia underwent curettage after having a spontaneous abortion. Among all patients of placenta previa, 9 patients had history of 1 previous c-section with incidence of 13% while 5 cases had history of 2 previous section with incidence of 7.6%. Placenta previa type 1 has an incidence of 12%, type 2-20%, type 3-38.4% and type 4-29.2%. The 76.9% patients of placenta praevia underwent caesarean section and 23% of patients underwent spontaneously delivery. APH can lead to a variable degree of maternal and perinatal mortality. Maternal mortality in study was 5% due to placenta previa and 7% due to abruption.

Conclusions: The incidence of APH could be reduced by taking some preventive measures like early registration, regular antenatal care, promptly detecting high risk cases, and early referral to higher centre. The incidence of maternal and fetal mortality due to abruption still remains high.

 


Keywords


Antepartum haemorrgahe, Placenta previa, Abruption placentae

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References


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

Myerscough PR. Antepartum hemorrhage: Placenta Previa, chapter 29, operative obstetrics, 10th Edition, Bailliere Tindall. 2004;400-14.

Oylese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005-16.

Roberts G. Unclassified antepartum hemorrhage incidence and perinatal mortality in a community. J Obstet Gynaecol Br. Commn W. 1970;77;492-5.

Arora R, Devi V, Majumder. Perinatal morbidity and mortality in Antepartum hemorrhage. J Obst Gyn India. 2001;51(3):102-4.

Bhide AG, Venkatraman V, Daftary SN. Factors affecting perinatal outcome in Antepartum hemorrhage. J Obstet Gynecol. 1990;40(1):517-20.

Bartlett LA. Risk factors for legal induced abortion-related mortality in the United States. Obstetr Gynecol. 2004;103(4):729-37.

Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior caesarean section. Obstet Gynecol. 1985;66(1):89-92.

Bahar A, Abusham A, Eskandar M. Risk factors and pregnancy outcome in different types of placenta previa. J Obstet Gynaecol Can. 2009;31:126-31.

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

Walfish M, Neuman A, Wlody D. Maternal hemorrhage. Br J Anesthesia. 2009;103:i47-56.

Harlev A, Levy A, Zaulan Y, Koifman A, Mazor M, Wiznitzer A. Idiopathic bleeding during the second half of pregnancy as a risk factor for adverse perinatal outcome. J Maternal Fetal Neonatal Med. 2008;21:331-5.

National Collaborating Centre for Women’s and Children’s Health. Intrapartum care: care of healthy women and their babies during childbirth. London: RCOG Press. 2007.

Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15-8.

Schuurmans N, MacKinnon C, Lane C, Etches D. Prevention and management of postpartum hemorrhage. Society of Obstetricians and Gynecologists of Canada Clinical Practice Guidelines No.88. J Soc Obstet Gynaecol Can. 2000;22:271-81.

Taylor, Francis. Clinical presentation and risk factors of placental abruption. Acta obstetricia et gynecological. Scandinavica. 2006;85(6):700-5.

Begley CM, Gyte GM, Murphy DJ, Devane D, McDonald SJ, McGuire Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2010;(7):CD007412.

Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307-10.

Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 2007;63:805-13.

Alexander JM, Sarode R, McIntire DD, Burner JD, Leveno KJ. Whole blood in the management of hypovolemia due to obstetric hemorrhage. Obstet Gynecol. 2009;113:1320-6.

Mercier FJ, Bonnet MP. Use of clotting factors and other prohemostatic drugs for obstetric hemorrhage. Curr Opin Anaesthesiol. 2010;23:310-6.

Royal College of Obstetricians and Gynaecologists. The Acute Management of Thrombosis and Embolism During Pregnancy and the Puerperium. Green-top Guideline No. 37b. London: RCOG. 2007.

Sarwar I, Abbasi AN, Islam A. Abruptio placenta and its complication at Ayub teaching hospital Abbottabad. J Ayub Med Coll Abbottabad. 2006;18:127-31.