Late Αntepartum Ηemorrhage and Neonatal Outcome: A Retrospective Study

Abstract

Objective: To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Methods: We retrospectively identified all eligible patients at a single institution from January 1990 to December 2012. A thorough research was made through patients' medical and obstetrical records. The various causes of late APH were compared to each other regarding the parameters of the neonatal outcome. Multiple regression models were applied for gestational age (GA) at birth, birth weight, Apgar score at first and fifth minute and selection of modus of delivery. Results: 480 patients were included in the study, in a total of 7221 pregnancies. The causes of APH were: cervical dilatation (n = 54, 11.3%), central placental abruption (n = 57, 11.9%), peripheral placental abruption (n = 59, 12.3%), placenta previa (n = 140, 29.2%), others non-related to pregnancy (n = 42, 8.8%), uterine rupture (n = 2, 0.4%) and unknown etiology (n = 126, 26.3%). Overall, 253 neonates (52.7%) were born prematurely at gestational age below 37th week. 37 pregnancies (7.7%) resulted in giving birth prior to 32 weeks of gestation. In multivariable analysis, the cause of hemorrhage was found to be an important independent predictive factor for gestational age (GA) at birth, birth weight, Apgar scores at first and fifth minute and modus of delivery. Preeclampsia, diabetes, thyroid disorder and smoking were associated with decrease of GA at birth. Birth weight below 1500 gr and GA at birth was found to be significant independent factors for Apgar score at first and fifth minute respectively. Modus of delivery did not significantly alter Apgar score. Conclusions: Late APH required immediate evaluation of the general condition of the pregnant woman and the fetus. The cause of APH was important in the prognosis of the neonatal outcome. As long as maternal and fetal status were ensured, expectant management, instead of emergency CS, seemed to be more beneficial even for late preterm neonates.

A Five-Year Review of Feto-Maternal Outcome of Antepartum Haemorrhage in a Tertiary Center in Nigeria

“…Prematurity and perinatal mortality was reported as the commonest fetal complications in Maiduguri, Nigeria [15] . Lower prematurity rate of 7.7% was reported in Greece [13] . Similar rate of stillbirth found in this study was reported in Kano, Nigeria and Tanzania [11,14] .…”

“…A lower prevalence of 1.2% was reported in Kano and higher prevalence rates of 5.1% and 15.3% reported in Ethiopia and Qatar respectively [4,11] . The commonest cause of APH in Kano, Nigeria, Ethiopia and India was abruptio placentae while placenta praevia was the commonest cause in Lagos, Nigeria and Greece [3,[10][11][12][13] . The prevalence rate of abruptio placentae in Tanzania was 2.5% and similar to the rate got in this study [14] .…”