A Study for Maternal and Fetal Outcome in Patients Presenting with Antepartum Hemorrhage

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 and ultimately the maternal and perinatal outcome in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH. Materials and methods: The present study was a prospective observational study undertaken during a period of 1 year from June 2016 to May 2017 in 54 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age willing to participate in study were included. Results: The incidence of antepartum hemorrhage was 0.8%.Placenta previa (51.85%) constituted the largest group. Maximum number of patients of APH belonged to the age group 25 to 29 years (40.7%) . In abruption 66.67% and in placenta previa 64.29% of the patients were multiparous.  In the undetermined group 57.15% of the patients were multiparous. In abruption, 50% of the patients and in placenta previa 39.28% were in the age group of 31-34 weeks and 6 days. In the present study, 62.95% of the patients were anemic at the time of admission. Majority 57.40% of the anemic patients had Hb of 7.0-9.9 gm.37% patients had Hb more than 10g/dl on presentation. History of previous cesarean section was there in 20.36% of the patients of APH.16.66% patients had preeclampsia as associated risk factor.The commonest mode of delivery was cesarean delivery i.e. 59.2%. In abruption 33.33% patients delivered by cesarean and 66.66% had normal vaginal delivery . 92.85% of placenta previa had cesarean section which was the largest group. Post partum hemorrhage was the most common complication observed in 9.2% of the cases.Majority (83.33%) of the patients in this study had no major maternal complications.Only 31.39% of the patients  required blood transfusions. IUD or still births were noted in 12.96% of the cases.                       Neoantal deaths were  observed in 3.7%. The largest group (37.03%) of the neonates were found to have low birth weight in the range of 2-2.5 kg. Prematurity was the most common complication observed in the present study in 50% of the cases. Majority of the premature infants i.e70.37%  were from placenta previa group NICU admissions were present in 44.44% of the cases. In the present study, 42.5% of the patients had an APGAR score of <7 at 1 min . Conclusion   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.                                  Index Terms:Antepartum hemorrhage,maternal ,perinatal,placenta previa,abruption placenta,post partum hemorrhage.