Study of etiopathology and risk factors of antepartum haemorrhage in a tertiary care center

Abstract

Background: Antepartum hemorrhage (APH) is an obstetrical emergency and is one of the leading causes of maternal and perinatal mortality and morbidity. Incidence varies from 2-5% of all deliveries. It contributes to 15-20% of all maternal deaths in India. Such obstetric emergency if handled carefully with identification of risk factors and timely management of cases can reduce chances of maternal and perinatal complications. Methods: The present study is an observational ambidirectional study focusing on antepartum haemorrhage and its maternal and perinatal outcomes in a tertiary care centre over 2 years, conducted in Dept. of Obstetrics and Gynecology of Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. A predesigned semi-structured, patient-friendly questionnaire was prepared based on the review of literature on Antepartum hemorrhage. Results: In our study it was observed that the mean age (in years) was 24.74(SD=2.83), 25.26(SD=5.48), 24 (SD=1.82) for Placenta Praevia, Abruptio Placenta & Indeterminate etiology respectively. All three groups were equally matched for maternal age as no significant difference was present in mean age of mother across all three groups (P=0.820 which is >0.05). We found that in our study, maximum patients were of upper lower socio-economic strata 33, followed by lower socio-economic status32; Lower middle group had 13 patients. In this study there were total 47 preterm deliveries (<37weeks) from all subtypes of APH. History from the patients was suggestive of total 29 cases with history of curettage or abortion. Out of those 29; 8 cases were of Placenta Praevia while 21 cases were of Abruptio. 12 cases had history of trauma. we also found that found total of 29 cases with history of infection & premature rupture of membrane. Out of these 29; 3 were of Placenta Praevia, 25 belonged to Abruptio & 1 of Indeterminate etiology. In our study we found 42 cases having a history of Preclampsia/Eclampsia. 1 case belonged to Placenta Praevia, 40 cases were of Abruptio & 1 of Indeterminate etiology. The association between APH subtype & history of preeclampsia/eclampsia was highly significant. Conclusions: From the results of our study, we conclude that antepartum haemorrhage is a major contributing factor to maternal and perinatal morbidity and mortality but when well-managed, outcome can be improved.