Cases Of Antepartum Hemorrhage Research Articles

Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in Central Punjab.

Objectives: Antepartum Hemorrhage is bleeding from or into the genital tract from the period of viability of fetus (28 weeks) till the end of second stage of labor. Antepartum hemorrhage is associated with a very high perinatal mortality rate. We present our experience of perinatal outcomes in cases of antepartum hemorrhage with the aim of highlighting the cause of antepartum hemorrhage and the adverse outcomes. Study Design: Descriptive Cross sectional study. Setting: Department of Gynecology & Obstetrics, Sargodha Medical College, Sargodha. Period: Jan 2018 to Jun 2018. Material and Methods: Ninety six pregnant patients between ages of 15-45 years diagnosed as cases of antepartum hemorrhage were enrolled. Patients with coagulation disorders, twin pregnancies, abnormal lie or presentation, previous scar and any known congenital anomaly. Cause of antepartum hemorrhage and mode of delivery was recorded. Perinatal outcomes were determined in terms of frequencies of perinatal mortality, stillbirth and low birthweight babies. Results: The etiology of antepartum hemorrhage in our setup was placenta previa (43.75%); placental abruption (37.5%); Toxemia (10.41%) and unclassified causes in 8.33% patients. The perinatal mortality rate was 43.75% in our study. The overall frequency of low birthweight babies and stillbirth was 62.5% and 27.08% respectively. Conclusion: Antepartum hemorrhage is a major cause of perinatal mortality in our country. A prompt diagnosis of the cause followed by early cesarean section can help reduce the overall mortality.

Antepartum haemorrhage

Antepartum haemorrhage is a relatively common entity with potentially serious implications for the mother and the fetus. Advances in obstetric care enable the clinicians to diagnose, anticipate, prevent and treat severe cases of antepartum haemorrhage in most patients. However, unexpected bleeding can occur even in low risk women receiving optimal antenatal care. Our review concentrates on two cases of antepartum haemorrhage due to placental abruption and morbidly adherent placenta respectively and highlights the predisposing factors, the management and the treatment according to evidence based practice and the most recent guidelines.

Massive or recurrent antepartum haemorrhage

Whilst the number of maternal deaths attributable to massive obstetric haemorrhage continues to fall, it is important not to become complacent. It can become life threatening in a very short space of time. The most recent death rate attributable directly to obstetric haemorrhage in the United Kingdom is 3.3/million maternities, the majority due to antepartum haemorrhage. If haemorrhage occurs antenatally not only are there consequences for the mother but also for the fetus. Recurrent antepartum haemorrhage is a condition which is often difficult to manage and the true significance of multiple minor episodes of bleeding may not be recognized. A multi-disciplinary team approach with good communication within the team is the key to successful management and good outcomes for these women and their babies. This article discusses three different cases of antepartum haemorrhage and their management.

Practice observed: is speculum examination on admission a necessary procedure in the management of all cases of antepartum haemorrhage?

The objective of the study was to determine the justification or otherwise of admission speculum examination in women presenting with antepartum haemorrhage and the outcome/ benefits of the practice on women with antepartum haemorrhage presenting to the delivery suite of a UK teaching hospital. Factors studied included gestational age at presentation, associated factors with the bleeding, grade of medical/ midwifery staff performing the admission speculum examination, findings on speculum examination and ultrasound scan and the overall pregnancy outcome. Of the 564 (4.9%) women who presented with antepartum haemorrhage; 521 had an admission speculum examination; 94.4% of these were by senior house officers (SHOs). The findings were a normal cervix (69%) and ectopy (21.3%). Of the women, 14.4% had recurrent bleeding and 8.5% went into preterm labour. The complications of the pregnancies, timing of delivery and management were independent of speculum examination. Admission speculum examination did not influence the management of pregnancies and the complications thereafter. These results suggest that such an intrusive procedure may not be justifiable in women presenting with antepartum haemorrhage.

A 4 year clinical experience of antepartum haemorrhage in Trinidad

A 4 year retrospective review was performed of 124 consecutive cases of antepartum haemorrhage from 21974 deliveries, an incidence of 0·56 per cent. Placenta praevia and placental abruption were pr...

SELECTIVE TREATMENT OF ANTEPARTUM HEMORRHAGE

Abstract 1. 1. There are presented the results of selective treatment of 191 cases of placenta previa with a mortality of 2.6 per cent, and 139 cases of accidental hemorrhage with a mortality of 2.9 per cent. 2. 2. These results, we believe, are comparable to those obtained by routine section in the treatment of these conditions and may avoid the additional risk of subsequent pregnancies by patients who have undergone cesarean section. 3. 3. All cases of antepartum hemorrhage should be treated in the hospital if at all possible, and as the diagnosis cannot always be accurately made when the first bleeding is only slight, this will entail hospitalizing patients who may subsequently be proved to have neither placenta previa nor accidental hemorrhage. 4. 4. In most emergencies of medical practice, where special skill is not available, conservative measures of treatment are usually in the best interests of the patient, but in placenta previa and probably in accidental hemorrhage, if skilled judgment is not available, radical method of treatment, namely cesarean section, is probably advisable.

Selective treatment of antepartum hemorrhage

1.1. There are presented the results of selective treatment of 191 cases of placenta previa with a mortality of 2.6 per cent, and 139 cases of accidental hemorrhage with a mortality of 2.9 per cent.2.2. These results, we believe, are comparable to those obtained by routine section in the treatment of these conditions and may avoid the additional risk of subsequent pregnancies by patients who have undergone cesarean section.3.3. All cases of antepartum hemorrhage should be treated in the hospital if at all possible, and as the diagnosis cannot always be accurately made when the first bleeding is only slight, this will entail hospitalizing patients who may subsequently be proved to have neither placenta previa nor accidental hemorrhage.4.4. In most emergencies of medical practice, where special skill is not available, conservative measures of treatment are usually in the best interests of the patient, but in placenta previa and probably in accidental hemorrhage, if skilled judgment is not available, radical method of treatment, namely cesarean section, is probably advisable.