Bharati Anup Rathi^1*, Sanjay Pundlik Pawar²

^1,1Associate Professor, Department of Obstetrics and Gynaecology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra, INDIA.

Email:  bharatikabra@rediffmail.com , dr.sanjaypawar40@yahoo.com

RESULTS

In present study 110 patients were included. Most patients had abruptio placentae (59%) followed by placenta previa (38%) and unclassified hemorrhage (3%). In present study most common age group was 25-29 years (51%) followed by 20-24 years (30%).

Table 1: distribution according to age and type of APH

Gestational age at the time of delivery was 28-32 weeks (31%), 33-36 weeks (36%) and ≥37 weeks (33%). Abruption was more common in less than 37 weeks gestation (45 %) as compared to placenta previa (22 %). All placenta previa patients were delivered by LSCS, most of them were elective. In abruptio placenta patients, after resuscitation, mode of delivery was planned, 23 patients required LSCS and rest 42 delivered vaginally. 10%, 18%, 26%, 40%, 5% required 5,4,3,1 or 2 and none units of blood transfusion respectively.

Table 2: Comparison of maternal characteristics in APH patients

Live births were 81 % in this study. Total IUFD, still births and NICU deaths were 27%. 14% babies required NICU admission. Average NICU stay was 9.7 ± 4.5 days. According to birth weight 32%, 39%, 19% and 10% had >2.5kg, 2-2.5kg, 1.5-2kgand1-1.5kg birth weight respectively

Table 3: Fetal outcome in APH patients

Most common maternal complications were PPH (39%), postpartum anemia ((35%) and hypovolemic shock (22%). Other complications were renal failure (10%), coagulation failure (5%) and sepsis (4%). We noted 3% mortality in present study.

Table 4: Maternal complications observed

DISCUSSION

Antepartum hemorrhage is an important cause of perinatal mortality and maternal morbidity in pregnant women. In developed countries, maternal mortality due to antepartum hemorrhage has been reduced significantly due to better obstetrical facility and care. But in developing countries like India maternal and perinatal mortality is still very high due to associated problems like anemia, difficulties in transport in cases of emergency and restricted medical facilities⁷. Maternal complications of antepartum haemorrhage are malpresentation, premature labour, postpartum haemorrhage, shock, retained placenta. It also includes higher rates of caesarean sections, peripartum hysterectomies, coagulation failure and death. Foetal complications are premature delivery, low birth weight, intrauterine death, congenital malformations and birth asphyxia. As the chief cause of APH in late pregnancy, the overall prevalence of placenta previa has been recently estimated to be approximately 5 per 1000 pregnancies by world region. Women with placenta previa are at an approximately 4-fold increased risk of second trimester vaginal bleeding and some women necessitate preterm cesarean section and hysterectomy for life-threatening hemorrhage^8,9. Placenta previa is one of the most serious complications during pregnancy and is associated with numerous adverse maternal and fetal-neonatal complications. Many of these are direct consequences of maternal antepartum and intrapartum hemorrhage¹⁰. Importantly, the prevalence of placenta previa has been rising in parallel with the increasing rate of cesarean delivery and varies throughout the world and it has become a serious public health problem worldwide¹¹. With the increase of gestational age, the risk of APH will increase in pregnant women with placenta previa. In present study most common age group was 25-29 years (51%) followed by 20-24 years (30%). Mean age of patients was 24.6 years. Mourya A et al.¹². noted that commonest age group was 21-29 years and mean age of 23 years and Bhandiwad A et al.¹³. reported a mean age of 23.3 ± 3.9 years with the most common age group being 20-29 yrs. In this studyconducted by P Rajini et al.¹⁴ the incidence of APH was found to be 1.29%, others reported higher percentage of APH i.e Samal SK et al.¹⁵ (2.9%)and Sheikh et al.¹⁶ (5.4%) in their studies. Perinatal outcome was poor in abruption as compared to placenta previa noted in other studies. The studies done by Maurya et al.¹²and Pandey et al.¹⁷ also showed the perinatal outcome to be worse in AP patients. Perinatal mortality in this study was 42% in APH comparable to 40% in study done by Nawrorji Wadia Hospital Mumbai. It is found that there is a strong relationship between APH and later development of intrapartum bleeding necessitating cesarean delivery¹⁸. Some women necessitate preterm cesarean section and hysterectomy for life-threatening APH, whereas others undergo elective cesarean section at term without hemorrhagic complications.

CONCLUSION

Adverse maternal and perinatal outcome was noted in patients with antepartum haemorrhage. Antenatal services, anemia correction, timely intervention (referral, caesarean section, liberal blood transfusion) and wider acceptance of expectant line of management in tertiary centre with neonatal intensive care unit will help to lower the perinatal and maternal morbidity and mortality.

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