Maternal and perinatal outcome in antepartum hemorrhage

Background: Antepartum hemorrhage is defined as any bleeding from or into the genital tract after the period of viability and before the end of second stage of labour. Aim: To study the maternal and perinatal outcome in antepartum hemorrhage. Materials and methods: The present study was a prospective observational study undertaken during a period of 2 years from September 2012 to August 2014 in 50 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 3.8%. Abruptio placenta (56%) constituted the largest group. Maximum number of patients was in the age group 20 to 30 years in both abruption (53.5%) and placenta previa (52.5%). In abruption 53.6% and in placenta previa 79% of the patients were multiparous. Majority (56%) of the patients with antepartum hemorrhage had GA of 28 to 34 weeks. Mean period of gestation in APH patients was 33.4 weeks. In abruption, 64% of the patients and in placenta previa 42% were in the age group of 31-34 weeks and 6 days. In the present study, 64% of the patients were anemic at the time of admission. Majority 34% of the anemic patients had Hb of 7.5-9.9 gm. Maximum 35.7% of the patients with abruption had Hb of 5 to 7.4 gm and 42.1% of patients with placenta previa had Hb of 7.5 to 9.9 gm. Pre-eclampsia (36%) was the most common risk factor for APH. The commonest mode of delivery was cesarean delivery i.e. 60%. In abruption majority 53.6% had normal delivery. 89.5% of placenta previa had cesarean section which was the largest group. Post partum hemorrhage was the most common complication observed in 22% of the cases. 5.3% of the patients with placenta previa had placenta accreta. DIC and renal failure were seen in 3.6% each. Majority (64%) of the patients in this study required blood transfusions. 64% of abruption and 68% of placenta previa patients required blood transfusion. IUD or still births were noted in 31% of the cases. Neoantal deaths were observed in 5.8%. Prematurity was the most common complication observed in the present study in 82.8% of the cases followed by neonatal jaundice which was observed in 51% of the cases. NICU admissions were present in 8.5% of the cases. In the present study, 56% of the patients had an APGAR score of <7 at 1 min and 63% had an APGAR of 4 to 6 at 5 min. Maximum number of births had birth weight of 1.5-2 Kg. In previa 17, majority (39.2%) of births had birth weight of 1.5-2 Kg and in undetermined majority (66.7%) had birth weight of 2.5-3 Kg. Conclusion: From the present study it can be concluded that antepartum hemorrhage is still a leading cause of maternal morbidity and mortality in our country.