A study of risk factors and fetomaternal outcome in patients with antepartum haemorrhage in a tertiary care centre
Keywords:Abruptio placenta, Antepartum haemorrhage, Fetomaternal outcome, Placenta previa
Background: Antepartum haemorrhage (APH) is one of the most feared complications in obstetrics, contributing to a significant amount of maternal and perinatal morbidity and mortality in our country. An antepartum haemorrhage is defined as bleeding into or from the genital tract from 24 weeks’ gestation and onwards, before the delivery of the baby. APH complicates about 2-5% of all the pregnancies with incidence of placenta previa (PP) about 0.33% to 0.55% and incidence of abruptio placenta (AP) about 0.5-1%. The maternal complications seen in patients with APH are malpresentations, premature labour, postpartum haemorrhage (PPH), sepsis, shock and retained placenta and the various foetal complications are preterm baby, low birth weight, intrauterine death, congenital malformation and birth asphyxia.
Methods: A 45 patients were included in this descriptive study and detailed history taking and clinical examination was done and the resultant maternal and neonatal outcome was noted.
Results: Incidence of APH in current study was calculated to be 0.53%. Out of the 45 patients, 28 (62.3%) were diagnosed with placenta previa and 17 (37.8%) were diagnosed with abruptio placenta. All 45 patients underwent caesarean section. 3 patients (6.6%) underwent obstetric hysterectomy due to diagnosis of placenta accreta spectrum. 35 alive and 8 dead born foetuses were delivered. 40% of new borns were admitted in NICU.
Conclusions: Antepartum haemorrhage is a major cause of maternal and perinatal morbidity and mortality which can be prevented by early antenatal registration, regular and frequent antenatal visits, early detection and labelling of high-risk cases, and early referral to higher centre when indicated.
Thomson AJ, Ramsay JE, Rich D. Antepartum hemorrhage. Royal College of Obstetricians and Gynecologists. Green-top Guideline No 63, 2011. Available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/antepartum-haemorrhage-green-top-guideline-no-63/. Accessed on 18 September 2023.
David A Miller. Treatment of Antepartum Hemorrhage. Women’s and children’s Hospital, Department of obstetrics and Gynecology, Los Angeles, USA.
Pattinson RC, Makin JD, Greyling K. A cohort analytical study to determine perinatal outcome of women with antepartum hemorrhage of uncertain origin. Tenth Conference on Priorities in Perinatal Care in South Africa, 1991.
Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap L, Rouse D, et al. Obstetrical hemorrhage. Williams Obstetrics. 23rd ed. New York, McGraw Hill Professionals; 2009.
Dutta DC. Antepartum hemorrhage. In: Hiralal Konar, editor. Textbook of obstetrics. 6th edition. JP Medical Ltd; 2015:243-61.
Park K. Preventive medicine in obstetrics, pediatrics and geriatrics. In: Park, textbook of preventive and social medicine. 19th ed. Bhanot; 2017:445-447.
Maurya A, Arya S. Study of antepartum haemorrhage & its maternal & perinatal outcome. Inter J Sci Res Public. 2014;4(2):57-64.
Adekanle DA, Adeyemi AS, Fadero FF. Antepartum hemorrhage and pregnancy outcome in Lautech teaching Hospital, southwestern Nigeria. J Med Sci. 2011;2(11):1243-7.
Alhubaishi F, Mahmood N. Prevalence and fetomaternal outcome of placenta previa at salmaniya medical complex, Bahrain. Cureus. 2022;14(8).
Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol. 1980;137(6):687-95.
Bhandiwad A, Bhandiwad AA. A study of maternal and fetal outcome in Antepartum hemorrhage. J Evidence-Based Med Health. 2014;1(6):406-27.
Bako B, Audu BM, Chama CM, Kyari O, Idrissa A. An 8 year clinical review of antepartum haemorrhage at the University of Maiduguri Teaching Hospital, Maiduguri. Borno Med J. 2008;5(2):14-21.
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Sponge CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. national institute of child health and human development maternal-fetal medicine units network. Obstet Gynecol. 2006;107(6):1226-32.
Gadgi RM, Rajaratnam A, Safoorah A. Maternal outcome in antepartum Haemorrhage: A study at a tertiary care Centre. Intl J of Clinical Obst Gynecol. 2020;4(5):05-08.
IU Takia, BM Sayyadi and HS Galadanaci. Antepartum hemorrhage: a retrospective analysis from a northern nigerian teaching hospital. Inter J Appl Basic Medi Res. 2017;7(2): 112-6.
Jaju KG, Kulkarni AP, Mundada SK. Study of perinatal outcome in relation to APH. Inter J Rece Trend Sci Technol. 2014; 11(3): 355-358.