Maternal and perinatal outcomes in cases of antepartum haemorrhage: a 3-year observational study in a tertiary care hospital

Abstract

Background: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study is to study the demographic profile, type of antepartum haemorrhage (APH), maternal and perinatal complications in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH.Methods: The study was a retrospective observational study conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry from November 2013- October 2016 [3 years]. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section. Statistical analysis done by using SPSS software version 21.Results: Total 218 cases were presented with APH and the incidence was 2.9%. Among these 49.5% were Placenta Praevia, 42.2% were abruption placentae, 6.8% cases were indeterminate (3 cases of vasa praevia and 12 cases of excessive show) and 1.5% cases were of extraplacental cause(Local causes). Most cases were multipara with most common age group was 26-30 years (42.2%). Pregnancy in most of the cases was terminated during 34-36+6 weeks of gestation (73.0%). Most common associated risk factors found were previous caesarean section, preeclampsia, previous history of curettage, malpresentation and anaemia. Postpartum haemorrhage was found in 42.2% cases while in 4 cases peripartum hysterectomy done. Most common perinatal complications were due to low birth weight (66.5%).Conclusions: The morbidity and mortality in pregnancies complicated with APH can be achieved by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care centre.

Consequences of antepartum hemorrhage and its maternal and perinatal outcome

“…The mean gestational age at delivery in present study was 35.22± 2.82 weeks and 60.1% of the patients in present study had preterm deliveries which was almost similar to studies conducted by Samal SK et al and Singhal S et al 14,15 This higher rate of preterm deliveries could be due to early decisions and surgical intervention in view of maternal health.…”

“…Neonatal death rate was 8.6%, 11.5% cases were of IUD and these were most commonly seen with abruption followed by placenta previa. Results were similar to studies conducted by Singhal S et al and Maurya A et al, Chufamo N et al, calculated the perinatal mortality to be 36.9% while Arora R et al 10,15,19,25 reported very high mortality rate of 61.5%. The lower neonatal death in present study may be due better neonatal care facilities with well-equipped NICU at our institute.…”

“…14,17 Malpresentations were seen in 5.2% cases which was consistent with the findings of Samal SK et al, Jejani A et al, and Sheikh F et al 13,14,18 In present study 63% patients underwent caesarean section, while 46% patients delivered vaginally. This was found consistent with the studies conducted by Chufamo N et al, Sheikh F et al, Adekanle DA et al, Samal SK et al and Arora R et al 10,12,15,18,19 This higher incidence of caesarean section was due to maternal indications which included hemorrhagic shock, major placenta previa and fetal indications like malpresentations, twins' gestations and acute fetal distress.…”

“…Our results were consistent with the findings of Adeknale DA et al, Rajini P et al, Samal SK et al, with 74.6%, 80.4% incidences of APGAR score >7 at 5 mins. 12,15,22 In present study the most common fetal complications observed were prematurity 25.8%, fetal distress 30%, asphyxia 12.2%, jaundice 7.1%, sepsis 2.1% still birth 2.8%, IUD 2.8%, early neonatal death 5.7%. This is consistent with the studies conducted by Singhal SR, et al, Samal SK et al, Taylor F et al, and Bhandiwad A et al 8,14,23,24 Perinatal mortality was observed in 20.1% of cases of APH in present study.…”

“…This was consistent with the studies conducted by Samal SK et al and Singhal et al, in which placenta previa was more common than abruption. 14,15 Association of abruption was commonly seen with primigravida and placenta previa was commonly seen with multigravida.…”