A Case Report on Life Threatening Hemorrhage in Preterm Pregnancy with Placenta Praevia and Management Challenges in a Low Neonatal Resourced Regional Hospital 187 km away from a Tertiary Center

Ayesha Akhter,Md Rafiqul Islam,Adebayo Adeyemi,Bruno Giorgio

doi:10.13189/ujph.2017.050604

Abstract

Placenta praevia is one of the obstetric emergencies, which can cause life threatening hemorrhage. Time interval to access support for these patients from emergency retrieval team are often challenging. Also, dilemmas may appear on taking decision for in-utero versus ex-utero transfer of neonates to tertiary hospital. In this case study, the patient presented with a life threatening antepartum hemorrhage (APH) in a low neonatal resourced regional hospital at 29 weeks of gestation. She was extremely needle phobic that delayed the resuscitation process. The overall situation and the patient's clinical condition were inappropriate for road transfer. Moreover, considering the weather condition on the day, air ambulance was grounded. Eventually, in-utero transfer of the neonate to tertiary hospital was impossible. As a result, she was delivered by an uncomplicated caesarean section and an initial resuscitation of the newborn was provided by the pediatric team of the hospital. Emergency neonatal retrieval team was able to arrive 3 hours after the birth for transferring the premature neonate to a tertiary center.

Highlights

Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the newborn [1]
If placenta covers cervical os it is called major placenta praevia and when it lies on the lower segment without covering the cervix is called minor placenta praevia
Routine morphology scan at 20 weeks of gestation usually can suggest placenta praevia

Summary

Introduction

Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the newborn [1]. APH associated with maternal or fetal compromise is an obstetric emergency. A low lying placenta occurs in 5% of

The Case

Findings

Discussion