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

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.