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Current Trends in Science and Technology

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

Vivek Kaushal, Neelam Mahajan, Anju Vij ,Amit Gupta
.
Online First: April 18, 2018
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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 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.

Keyword : .

  Submitted
Apr 18, 2018
Published
Apr 18, 2018
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References

1. Lolonde A, Davis BA, Acosta A. Postpartum haemorrhage today: ICM/FIGO initiative 2004-2006 UGO. 2006;94:243-53. 2. Dutta DC. Antepartum haemorrhage. In Konar. HL ed. Textbook of obstetrics. 6th ed. Kolkatta:New central book agency;2006:243-246. 3. Sheikh F, Khokhar S, Sirichand P, Shaikh R. A study of antepartum haemorrhage: Maternal and perinatal outcome. Medical Channel. 2010;16(2):268-71. 4. Nicholas Ngeh, Amarnath Bhide (2006) Antepartum haemorrhage. Current obstetrics & Gynaecology 16(2): 79-83. 5. Harrison KA (1985) Maternal mortality. Brt J Obstet Gynecol 5(Suppl): 100-115. 6. Ayushma J, Anjali K. Study of obstetric outcome in antepartum haemorrhage. Pana J Med Sci. 2015;5(3):153-7. 7. Bhide AG, Venkatraman V, Daftary SN. Factors affecting perinatal outcome in Antepartum hemorrhage. J. Obstet Gynecol 1990; 40, No.1; 517-520. 8. Ambarisha Bhandiwad, Abhishek A. Bhandiwad. A study of maternal and fetal outcome in Antepartum haemorrhage. Journal of evidence based medicine and healthcare, 2014; 1(6): 406-427. 9. Arora R, Devi U, Majumdar R. Perinatal morbidity and mortality in antepartum hemorrhage. J Obstet Gynae India 2001;51(3):102-4. 10. G. Sharmila, Prasanna. Maternal and perinatal outcome in antepartum hemorrhage. IAIM, 2016; 3(9): 148-160. 11. Archana Maurya, .Sonal Arya. Study of antepartum hemorrhage and its maternal and fetal outcome. International Journal of Scientific and Research Publications, 2014; 4(2): 1-8. 12. Adekanle A, Adeyemi A, Fadero F. Antepartum haemorrhage in LAUTECH TeachingbHospital, South‑Western Nigeria. J Med Sci 2011;2:1243-7. 13. Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol., 1980; 164: 687-695. 14. Crenshaw C Jr., Jones DE., Parker RT. Placenta previa: a survey of twenty years experience with improved perinatal survival by expectant therapy and cesarean delivery. Obstet Gvnecol Surv., 1973; 28(7): 461-70. 15. Chakraborty B, De KC. Evaluation of third trimester bleeding with reference to maternal and perinatal outcome. J. Obst Gyne India, 1993; 42: 166-71. 16. Sarwar I, Abbasi AN, Islam A. Abruptio placenta and its complication at Ayub teaching hospital Abbottabad. J. Ayub Med coll Abbottabad 2006; 18: 127-131. 17. William MA, Mittendorf R. Increasing maternal age, a determinant for placenta previa? More important than increasing parity PJ Reprod Med., 1993; 38: 425-8. 18. B. Bako, B. M. Audu, C. M. Chama, O. Kyari, A. Idrissa. A 8 year clinical review of antepartum hemorrhage 1999-2006 ; BOMJ, 2008; 5(2): 14-21. 19. Archana Maurya, .Sonal Arya. Study of antepartum hemorrhage and its maternal and fetal outcome. International Journal of Scientific and Research Publications, 2014; 4(2): 1-8. 20. Kalavati Girdharilal Jaju, A P Kulkarni, Shivprasad Kachrulal Mundada. Study of perinatal outcome in relation to APH. International Journal of Recent Trends in Science and Technology, 2014; 11(3): 355-358. 21. S Singhal,Nymphaea,Snanda.Maternal and perinatal outcome in APH:A Study at a tertiary care referral institute The Internal Journal of Gynaecology and Obstetrics 2007:2009. 22. Sheikh F, Khokhar S. A study of antepartum haemorrhage: Maternal and perinatal outcomes. Med Chan 2010;16:22. 23. Kedar K et al.Int J Reprod Contracept Obstet Gynecol.2016 May;5(5):1386-1393.
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References

1. Lolonde A, Davis BA, Acosta A. Postpartum haemorrhage today: ICM/FIGO initiative 2004-2006 UGO. 2006;94:243-53.
2. Dutta DC. Antepartum haemorrhage. In Konar. HL ed. Textbook of obstetrics. 6th ed. Kolkatta:New central book agency;2006:243-246.
3. Sheikh F, Khokhar S, Sirichand P, Shaikh R. A study of antepartum haemorrhage: Maternal and perinatal outcome. Medical Channel. 2010;16(2):268-71.
4. Nicholas Ngeh, Amarnath Bhide (2006) Antepartum haemorrhage. Current obstetrics & Gynaecology 16(2): 79-83.
5. Harrison KA (1985) Maternal mortality. Brt J Obstet Gynecol 5(Suppl): 100-115.
6. Ayushma J, Anjali K. Study of obstetric outcome in antepartum haemorrhage. Pana J Med Sci. 2015;5(3):153-7.
7. Bhide AG, Venkatraman V, Daftary SN. Factors affecting perinatal outcome in Antepartum hemorrhage. J. Obstet Gynecol 1990; 40, No.1; 517-520.
8. Ambarisha Bhandiwad, Abhishek A. Bhandiwad. A study of maternal and fetal outcome in Antepartum haemorrhage. Journal of evidence based medicine and healthcare, 2014; 1(6): 406-427.
9. Arora R, Devi U, Majumdar R. Perinatal morbidity and mortality in antepartum hemorrhage. J Obstet Gynae India 2001;51(3):102-4.
10. G. Sharmila, Prasanna. Maternal and perinatal outcome in antepartum hemorrhage. IAIM, 2016; 3(9): 148-160.
11. Archana Maurya, .Sonal Arya. Study of antepartum hemorrhage and its maternal and fetal outcome. International Journal of Scientific and Research Publications, 2014; 4(2): 1-8.
12. Adekanle A, Adeyemi A, Fadero F. Antepartum haemorrhage in LAUTECH TeachingbHospital, South‑Western Nigeria. J Med Sci 2011;2:1243-7.
13. Cotton DB, Read JA, Paul RH, Quilligan EJ. The conservative aggressive management of placenta previa. Am J Obstet Gynecol., 1980; 164: 687-695.
14. Crenshaw C Jr., Jones DE., Parker RT. Placenta previa: a survey of twenty years experience with improved perinatal survival by expectant therapy and cesarean delivery. Obstet Gvnecol Surv., 1973; 28(7): 461-70.
15. Chakraborty B, De KC. Evaluation of third trimester bleeding with reference to maternal and perinatal outcome. J. Obst Gyne India, 1993; 42: 166-71.
16. Sarwar I, Abbasi AN, Islam A. Abruptio placenta and its complication at Ayub teaching hospital Abbottabad. J. Ayub Med coll Abbottabad 2006; 18: 127-131.
17. William MA, Mittendorf R. Increasing maternal age, a determinant for placenta previa? More important than increasing parity PJ Reprod Med., 1993; 38: 425-8.
18. B. Bako, B. M. Audu, C. M. Chama, O. Kyari, A. Idrissa. A 8 year clinical review of antepartum hemorrhage 1999-2006 ; BOMJ, 2008; 5(2): 14-21.
19. Archana Maurya, .Sonal Arya. Study of antepartum hemorrhage and its maternal and fetal outcome. International Journal of Scientific and Research Publications, 2014; 4(2): 1-8.
20. Kalavati Girdharilal Jaju, A P Kulkarni, Shivprasad Kachrulal Mundada. Study of perinatal outcome in relation to APH. International Journal of Recent Trends in Science and Technology, 2014; 11(3): 355-358.
21. S Singhal,Nymphaea,Snanda.Maternal and perinatal outcome in APH:A Study at a tertiary care referral institute The Internal Journal of Gynaecology and Obstetrics 2007:2009.
22. Sheikh F, Khokhar S. A study of antepartum haemorrhage: Maternal and perinatal outcomes. Med Chan 2010;16:22.
23. Kedar K et al.Int J Reprod Contracept Obstet Gynecol.2016 May;5(5):1386-1393.
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