Study on fetomaternal outcome in antepartum haemorrhage

Background: Any bleeding from or into the genital tract after the period of viability, but before the birth of the baby is termed as antepartum haemorrhage (APH).Methods: 110 cases of bleeding per vaginal (pv) after 28 weeks of gestation were studied retrospectively from August 2018 to June 2019 and were grouped as placenta previa, placental abruption and indeterminate.Results: 35.45% cases were of placenta previa, 53.63% cases were of placental abruption and 10.90% cases were of indeterminate. Majority were delivered by lower segment caesarean section (LSCS) and most of the cases required blood transfusion.Conclusions: APH cannot reliably be predicted .It is major cause of maternal and perinatal mortality and morbidity. Multidisciplinary approach and senior input is necessary in making decision about timing and mode of delivery. Presently increase in use of ultrasonography (USG) for placental localisation and to diagnose abruption, improved obstetrical and anesthetic facilities, increase in use in blood products to correct anemia and advanced neonatal care facilities, all of these have played important role in decreasing perinatal as well as maternal mortality and morbidity

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Causes and management of secondary postpartum haemorrhage in a tertiary medical college hospital in Bangladesh

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172896 ◽

2017 ◽

Vol 6 (7) ◽

pp. 2694

Author(s):

Kamrun Nessa ◽

Sumia Bari ◽

Sanjida Khan ◽

Ferdowsi Sultana ◽

Tania Akbar

Keyword(s):

Maternal Morbidity ◽

Postpartum Haemorrhage ◽

Mode Of Delivery ◽

Wound Dehiscence ◽

College Hospital ◽

Mortality And Morbidity ◽

Medical College ◽

Maternal Mortality And Morbidity ◽

Postnatal Women ◽

Low Incidence

Background: Globally postpartum haemorrhage remains a leading cause of maternal death. It affects only 1-2% of postnatal women. This low incidence of secondary PPH and linkage to maternal morbidity rather than mortality was the reason for the little attention among obstetricians, but it is recently gaining importance and interest with the increase morbidity and mortality related to secondary PPH.Methods: A retrospective study was conducted on the diagnosed patients of secondary PPH admitted in Enam Medical College and Hospital, Dhaka, Bangladesh, from January 2015 to December 2016. Among 33 cases of secondary PPH age of the patients, parity, mode of delivery, causes and management were noted from medical records. All data was analyzed by SPSS16.Results: Among 33 patients 14 (42.4%) were primi and 19 (57.6%) were multipara, age between 18 to 38 years, majority admitted 2nd and 3rd week after delivery. Among 33 patients 12% delivered vaginally at home and 30% vaginally at hospital and 58% undergone LUCS. We found 34% retained bits of placenta, 27% uterine wound dehiscence, 24% retained clots and 15% endometritis as causes. Less than 3 units blood needed in 22 (66.7%) patients and 11 (33.3%) needed more than 3 units. About 6 (18%) patients were treated conservatively, MVA were needed in 18 (55%) patients, repair of wound in 4 (12%) and TAH was in 5 (15%).Conclusions: Secondary PPH is increasing may result in significant maternal morbidity as well as mortality. More study needed to identify the risk factors and causes to reduce maternal mortality and morbidity.

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Study of antepartum hemorrhage and its maternal and perinatal outcome at a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212149 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2210

Author(s):

Amruta R. Kulkarni ◽

Arti S. Shirsath

Keyword(s):

Maternal Mortality ◽

Perinatal Mortality ◽

Perinatal Outcome ◽

Placenta Previa ◽

Tertiary Care ◽

Care Hospital ◽

Mortality And Morbidity ◽

Antepartum Haemorrhage ◽

Medical College ◽

Abruptio Placenta

Background: Antepartum haemorrhages are defined as bleeding from or into the genital tract after the period of viability untill delivery of the fetus. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Objective of this study is to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care hospital.Methods: A retrospective observational study was carried out in the department of obstetrics and gynecology, Smt. Kashibai Navale medical college and general hospital, Pune. Patient information was obtained from the delivery records of 2018, 2019 and 2020. Patients presenting after the gestational age of 28 weeks with antepartum haemorrhage were included in the study.Results: Out of 100 cases of APH, abruptio placenta contributes to 60%, placenta previa to 37% and 3 cases were due to unknown cause. Overall maternal mortality was 3% and perinatal mortality was 23% in abruptio placentas compared to 13% in cases with placenta previa. Main cause of perinatal mortality was prematurity69%.Conclusions: Antepartum haemorrhage is one of the leading cause of perinatal mortality and morbidity. These cases should be deliverd at a centre with transfusion facility, NICU facility and by the obstetrician skilled in controlling intraoperative haemorrhage by stepwise devascularising sutures. Timely decision of uterine tamponade can also save few ceaserean hysterectomies.

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Study of fetomaternal outcomes in antepartum haemorrhage at tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211129 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1509

Author(s):

Faaizah Husain Ghanchibhai ◽

Sharda Goyal ◽

Nalini Sharma ◽

Ankita Pargee

Keyword(s):

Mortality Rate ◽

Maternal Mortality ◽

Perinatal Mortality ◽

Placenta Previa ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Maternal Complications ◽

Mortality And Morbidity ◽

Antepartum Haemorrhage ◽

Abruptio Placenta

Background: Antepartum haemorrhage (APH) is a challenge to obstetrician as it involves a question of life and death to mother and fetus. Antepartum hemorrhage is the 2nd most common cause of maternal mortality and morbidity as sepsis and obstructed labour has decreased now. The aim of the study is to find the prevalence of APH. And to study foeto-maternal outcomes in patients with antepartum haemorrhage, association of comorbidities and risk factors.Methods: This study was conducted at Geetanjali Medical College and Hospital, Udaipur after obtaining approval from institutional research ethical board and written informed consent during the period of February 2019 to July 2020. This was prospective observational study, sample size was 60 patients. All the APH patients who were admitted at GMCH Obstetrics and Gynaecology department after 28 weeks of gestation were included in study. Extrauterine or bleeding due to general pathology was excluded. Total number of delivery were 1900 in above duration and number of APH patients were 60, so our incidence is 3.1%.Results: Total number of delivery were 1900 in above duration and number of APH patients were 60, so our incidence is 3.1%. According to maternal complications rate, It was 66.66 % in abruptio placenta, 37.03 % in placenta previa and jointly 53.33%. In placenta previa group 100% patients discharged with good GC, In abruptio placenta group 96.96% patients discharged with good GC and 3.04% patients discharged with poor GC. Perinatal mortality was zero in placenta previa group and in abruptio placenta, it was 27.27% (24.24% IUD, 3.03% neonatal death).Conclusions: The main cause of APH was abruption which was seen in 33 (55%) of patients and placenta previa was seen in 27 (45%) of patients. Maternal and neonatal complications, both were very high in abruption group as compared to placenta previa group. Overall maternal mortality rate was 53.33% and perinatal mortality rate was zero in placenta previa group while in abruption placenta group, it was 27.27%. There was no maternal complications in booked placenta previa cases only there were very few complications in emergency cases. In abruptio placenta group also complications were more in emergency cases, irregular booked and uncontrolled pregnancy pathology cases.

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Incidence and indications of LSCS among Doctors Community of Chattogram

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v20i2.56471 ◽

2021 ◽

Vol 20 (2) ◽

pp. 37-40

Author(s):

Adiba Malik ◽

Kamrun Nessa ◽

Yasmin Ara Begum ◽

M Jalal Uddin ◽

Aklima Sultana ◽

...

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Placenta Previa ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Fetal Distress ◽

Left Ventricular ◽

Subsequent Pregnancy ◽

Cross Sectional ◽

Lower Segment Caesarean Section

Background: Lower segment caesarean section (LSCS) is a surgical intervention, which is carried out to ensure the safety of mother and baby when vaginal delivery is not possible or when danger to mother and baby would be greater with vaginal delivery. This study is designed to identify indication of LSCS and detect complications if any among the respondents. Materials and methods: Cross sectional descriptive study where 95 female doctors of Chattogram were selected by convenient sampling without knowing their mode of delivery and if it is LSCS then indication of LSCS , maternal and neonatal complications were noted. Results: Age of the respondents at the time of interview were noted and most of them were between 31- 40 years 52 (55%), regarding income most of them between 100000 -200000 42(44%) most of the delivery occurred in the private clinics 92 (70%) regarding mode of delivery, LSCS was 92 (70%) vaginal delivery 40 (30%) regarding indications of LSCS most common was repeat caesarean section 27 (29%) and second common was LSCS due to maternal interest 18 (20%) and others were severe preeclampsia 10 (11%) fetal distress 08(09%) placenta previa, Diabetes with big baby, cephalopelvic disproportion, PROM with non progression of labour. PPH was the most common complication 05 (63%), next was paralytic ileus 02 (25%) and left ventricular failure 01 (12%). Common neonatal comoplications were low birth weight baby 904 (40%), prematurity 03 (30%) and birth asphyxia 03 (03%). Conclusion: LSCS is a major surgical procedure for delivery. Inspite of its low maternal morbidity and mortality due to improved surgical technique, modern aneasthetic skill and availability of blood and blood products, still it carries a slightly greater risk in subsequent pregnancy, so we should be rational in doing primary caesarean section. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 37-40

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A study of pregnancy outcome in patients with cardiac disease

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184977 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5111

Author(s):

Pradnya D. Kamble ◽

Amarjeet Kaur Bava

Keyword(s):

Heart Disease ◽

Cardiac Disease ◽

Tertiary Care ◽

Cardiac Complications ◽

Care Centre ◽

Tertiary Care Centre ◽

Mortality And Morbidity ◽

Lower Segment Caesarean Section ◽

Maternal Mortality And Morbidity ◽

Rheumatic Heart

Background: Cardiac disease is a leading cause of maternal mortality and morbidity. Timely diagnosis and appropriate management can significantly improve the maternal and perinatal outcome.Methods: This prospective observational study was performed over a period of 18 months at a tertiary care centre in Mumbai. A total of 100 women with heart disease were included in the study. The subjects were followed up during the antenatal, intrapartum and postpartum period to study the maternal and perinatal outcome.Results: Out of 14791 confinements 100 consenting patients were included in the study. The incidence of heart disease came out to 0.9%. Rheumatic heart disease (RHD) was seen more commonly as compared to congenital heart disease (CHD) and peripartum cardiomyopathy. 64% patients delivered vaginally out of which 8% had instrumental delivery and 28% underwent a lower segment caesarean section (LSCS). 21% patients had cardiac complications like pulmonary edema, arrhythmias, sepsis, DIC etc. and there were 3 maternal mortalities. 58% of the babies were born low birth weight, 90.9% of the babies had an Apgar score of >7. 60% of the babies were born at term whereas 26% had a preterm delivery.Conclusions: Patients of cardiac disease with pregnancy need to be managed at a tertiary care centre by a multidisciplinary team of doctors. Early diagnosis of heart disease and stringent management of complication is of utmost importance. Vaginal delivery is favourable and LSCS should be performed for an obstetric indication. Maternal heart disease leads to an increased incidence of preterm delivery and hence a joint care of neonatologist is mandatory in managing these patients.

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Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v1i2.223 ◽

2020 ◽

Vol 1 (2) ◽

pp. 78-84

Author(s):

Teddy Wijaya

Keyword(s):

High Risk ◽

Multidisciplinary Approach ◽

Placenta Accreta ◽

Placenta Previa ◽

Risk Map ◽

Secondary Complications ◽

Repeat Surgery ◽

Mortality And Morbidity ◽

Fetal Position ◽

Transverse Lie

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

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Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v1i2.139 ◽

2021 ◽

Vol 1 (2) ◽

pp. 78-84

Author(s):

Raden Theodorus Soepraptomo ◽

Fitri Hapsari ◽

Teddy Wijaya

Keyword(s):

High Risk ◽

Multidisciplinary Approach ◽

Placenta Accreta ◽

Placenta Previa ◽

Risk Map ◽

Secondary Complications ◽

Repeat Surgery ◽

Mortality And Morbidity ◽

Fetal Position ◽

Transverse Lie

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Effectiveness of Utero-Vaginal Packing in Management of Postpartum Hemorrhage

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1513 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Lubna Javed ◽

Shamila Ijaz Munir ◽

Amna Zia Eusaph

Keyword(s):

Postpartum Hemorrhage ◽

Genital Tract ◽

Placenta Previa ◽

Angiographic Embolization ◽

Management Options ◽

Effective Measure ◽

Iliac Arteries ◽

Mortality And Morbidity ◽

Lower Segment Caesarean Section ◽

Internal Iliac

A major cause of maternal mortality and morbidity in developing world is postpartum hemorrhage (PPH). Different management options have been in use including use of oxytocins, prostaglandins, surgical exploration of genital tract, ligation or angiographic embolization of uterine/internal iliac arteries and hysterectomy. A simple and effective measure is to control bleeding with uterovaginal packing which is easy and quick to perform and saves the patient need of major surgical procedures.Objective: To determine effectiveness of uterovaginal packing in control of postpartum hemorrhage, its safety and complications associated with it.Place and Duration of Study: This study was carried out in Gynae unit 1 of Lady Willingdon Hospital Lahore from January 2014 – June 2015.Patients and Methods: It was a prospective interventional study. The patients presenting with postpartum hemorrhage after vaginal or abdominal delivery who did not respond to medical management were included in the study. Patients who had PPH due to genital tract trauma were excluded from this study. Frequencies and proportions of complications were calculated along with rate of successful cessation of bleeding. Data was analyzed by SPSS version 11.Results: 99 patients who presented with PPH were included in study.49.5% were between age of 31 – 40 years, 38.4% were between 21– 30 years. 8.1% of patients were P1-2, 52.5% were P3-5 and 39.4% were P6 and above. 76.7% had hemorrhage after vaginal delivery and 23.3% after lower segment caesarean section. Uterineatony was the most common cause of postpartum hemorrhage, seen in 78.78% of cases, 9.09% had placenta previa, 8.08% presented with abruption placenta and 4.04% had coagulopathy. Regarding complications 7 women had to undergo hysterectomy, fever occurred in 14.14%, 8.08% had wound infection and 2 patients died of Disseminated Intravascular Coagulation (DIC). Procedure was successful in 90.9% of cases.Conclusion: Utero-vaginal packing effectively controls postpartum hemorrhage with fewer complications and its role in emergency obstetric scan not be denied.

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Incidence of antepartum haemorrhage in pregnancy and its maternal-fetal outcome in admitted antenatal patients in tertiary care centre, Bhilai Durg, Chhattisgarh

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211111 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1406

Author(s):

Seema Khandasu ◽

Pooja Singh ◽

Rekha Ratnani

Keyword(s):

Maternal Morbidity ◽

Neonatal Intensive Care ◽

Placenta Previa ◽

Tertiary Care ◽

Expectant Management ◽

Fetal Outcome ◽

Perinatal Morbidity ◽

Tertiary Care Centre ◽

Mortality And Morbidity ◽

Antepartum Haemorrhage

Background: Antepartum haemorrhage has always been one of the deadliest complications in obstetrics. Antepartum haemorrhage (APH) complicates about 2-5% of pregnancies. Maternal and perinatal morbidity and mortality associated with APH can be reduced significantly by aggressive expectant management. The present study was conducted to assess maternal and fetal outcome in patients with antepartum haemorrhage. Aims and objectives were to study the incidence of antepartum haemorrhage at SSIMS hospital. To highlight the importance of early diagnosis and treatment. To study the maternal and fetal outcome in antepartum haemorrhage. To study the associated risk factors contributing to maternal and fetal morbidity and mortality.Methods: The study was conducted in Shri Shakaracharya Institute of Medical Sciences, Bhilai, Durg, Chhattisgarh during the period of January 2020 to December 2020 after getting approval from the institutional ethical committee. 31 cases of APH with gestational age ≥28 weeks were included. They were distributed according to type of APH into abruptio placentae (AP), placenta previa (PP). Causes of APH were noted and maternal as well as perinatal outcome observed.Results: In the present study it was observed that incidence of APH was 2% out of 1503 deliveries. Out of 31 cases, 54.83% was AP followed by PP 45.16%. Abruption was the commonest cause of APH with its associated maternal morbidity and perinatal mortality and morbidity. Anemia was the most common complication in APH. Prematurity of the neonate was a serious complicating factor in APH. No maternal mortality was seen in this study.Conclusions: Overall incidence of APH has remained high. Though maternal morbidity is reduced with modern management of APH, but timely diagnosis and intervention is necessary. Perinatal morbidity can be reduced with good neonatal intensive care facilities.

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Assisted reproductive technologies (ART) and placental abnormalities

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0141 ◽

2020 ◽

Vol 48 (8) ◽

pp. 825-828

Author(s):

Elizabeth Cochrane ◽

Christine Pando ◽

Gregory W. Kirschen ◽

Devon Soucier ◽

Anna Fuchs ◽

...

Keyword(s):

Umbilical Cord ◽

Primary Outcome ◽

Placental Abruption ◽

Assisted Reproductive Technologies ◽

Placenta Previa ◽

Mode Of Delivery ◽

Reproductive Technologies ◽

The Relationship ◽

Umbilical Cord Insertion ◽

Velamentous Cord Insertion

AbstractObjectivesAssisted reproductive technologies (ART) may be associated with placental abnormalities including placenta previa, umbilical cord abnormalities, and placental abruption. Our study evaluates the relationship between ART and placental abnormalities compared with spontaneously conceived controls.MethodsAn IRB-approved cohort study was conducted including women who delivered between January 2013 and December 2018. We excluded delivery prior to 23 weeks and known fetal anomalies. Patients were matched with controls (2:1) for parity, age, and mode of delivery. Controls were women who had spontaneously conceived and delivered immediately preceding and following the index delivery. The primary outcome was placental abnormalities found on both antenatal ultrasound and pathology in ART gestations compared with spontaneously conceived gestations.ResultsThere were 120 ART pregnancies and 240 matched control pregnancies identified. The groups were similar for parity, BMI, comorbidities, number of multiples, mode of delivery, and female newborns. The ART group had a higher maternal age (37.1±5 y vs. 30.0±5 y; p<0.001), greater preterm birth (29 vs. 6%; p<0.001), and lower BW (2,928±803 g vs. 3,273±586 g; p<0.001). The ART group had a higher incidence of placenta previa on ultrasound (4.0 vs. 0.4%, p=0.01), adherent placentas at delivery (3 vs. 0% p=0.014), placental abruption (2 vs. 0%; p=0.04), as well as an increased rate of velamentous cord insertion (12 vs. 3%, p<0.001) and marginal cord insertion (28 vs. 15%, p=0.002). ART demonstrated a two-fold likelihood of abnormal placental pathology.ConclusionsART is associated with increased rate of placental abnormalities, including abnormal umbilical cord insertion and increased rates of adherent placentation. This information may be beneficial in planning and surveillance in patients with ART pregnancies.

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