Identifying the risk factors of antepartum haemorrhage and to evaluate the feto maternal outcome in antepartum haemorrhage cases

Background: Antepartum haemorrhage is an obstetric emergency contributing to a significant percentage of perinatal and maternal morbidity and mortality. Approximately 30% of maternal deaths are caused by ante-partum haemorrhage. In spite of a lot of improvement in antenatal care and intrapartum surveillance, antepar-tum haemorrhage has not reduced. Present study was conducted to assess the causes of APH and to compare the fetomaternal outcome among placenta previa and abruptio placenta group.Methods: The study was conducted in BRD medical college Gorakhpur, over a period of 1 year (October 2019 to September 2020) in which 100 cases of APH were taken and classified into placenta previa and abruptio placenta group and their fetomaternal outcome were compared.Results: In our study, out of 100 cases of APH 69% cases were of placenta previa followed by abruptio placen-ta in 29% cases and rest 2% cases were unclassified APH. Multigravida is the major risk factor in both placenta previa and abruptio placenta group. Second major risk factor in placenta previa group was h/o LSCS and in abruptio placenta group was HDP. Stillbirth was significantly seen in abruptio placenta group whereas Low birth weight babies (1.5-2.5 kg) were more in placenta previa group. Though the maternal outcome is poor in placenta previa group but the fetal outcome is worse in abruptio placenta group.Conclusions: APH neither can be reliably predicted nor can be prevented but only a comprehensive focused experienced team work can reduce maternal and perinatal morbidity and mortality.

1332Endometriosis, assisted reproductive technology and adverse pregnancy outcomes: a population based data linkage study

Background Endometriosis is a chronic inflammatory disease characterised by endometrial tissue outside the uterus – pain and infertility are common symptoms. There is a paucity of data on the association between endometriosis and adverse pregnancy outcomes where the contribution of assisted reproductive technology (ART) use is also considered. This study will examine the association between endometriosis, with and without ART use, on adverse pregnancy outcomes. Methods Population data linkage study of all female NSW residents aged 15-45 years with a singleton birth in 2006-2015. Pregnancies were classified into 4 groups based on endometriosis diagnosis (yes/no) and ART use (yes/no). Multinomial logistic regression was used to estimate the odds of adverse pregnancy outcomes with 99% confidence intervals, adjusting for maternal and pregnancy factors. Outcomes assessed included placenta praevia, antepartum haemorrhage, planned birth (induction of labour or caesarean section) and preterm birth. Results Of 889,101 eligible pregnancies, women with endometriosis were more likely to be older while women who used ART were more likely to be nulliparous, birth in a private hospital and less likely to smoke. Adjusted odds ratios for selected study outcomes are outlined below. Conclusions Endometriosis is associated with increased odds of preterm birth, placenta praevia, antepartum haemorrhage and planned birth. In general, the odds of adverse pregnancy outcomes associated with endometriosis were further increased with ART use. Key messages These findings suggest that women with endometriosis, especially those who achieved pregnancy via ART use, represent a high risk obstetric population requiring appropriate surveillance and management.

Maternal and Fetal Outcome in Antepartum Haemorrhage of Unknown Origin in Chennai, India

BACKGROUND Antepartum haemorrhage of unknown origin (APHUO) being a diagnosis of exclusion, is a rare condition which poses dilemma in the management of pregnancy in terms of timing and mode of delivery. The purpose of this study was to evaluate antenatal factors associated with APHUO, clinical presentation and analyse its impact on pregnancy and its outcome. METHODS This is a retrospective study conducted over a period of two years in a tertiary care hospital. Pregnancy outcomes were compared between 41 cases who had APHUO versus 39 controls who never had history of bleeding in their antepartum period. Bleeding pattern, incidence of preterm labour, intra partum and postpartum complications, mode of delivery, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score of the baby and neo-natal intensive care unit (NICU) admission were analysed. RESULTS Patients with APHUO had subclinical abruption and increased risk of preterm delivery. Intrapartum and postpartum complications were similar among both the groups. The average birth weight was much lesser in the study group, but the cause was attributed to prematurity. These findings were consistent with the previous studies. CONCLUSIONS APHUO is associated with subclinical abruption and increased risk of preterm labour. Hence the patient should be counselled for delivery at a tertiary care center with adequate neonatal care. Greater incidence of NICU admission and low birth weight were attributed to prematurity among the study group. Induction of labour at term in this group is of questionable value unless there is an associated obstetric indication. KEY WORDS APHUO, Preterm Labour, Sub Clinical Abruption, Low Birth Weight

Antepartum Haemorrhage: The Arguments and Its Implication to Muslim Parturient

Pregnancy and bleeding throughout pregnancy are the two entities that cannot be separated. The implication of this issue leads to differences of thought, understanding and interpretation of the Islamic law, and affect the consequences of ibadah, worship to God. Although there are many resources that explores about this issue, but the understanding among parturient is seen inconclusive. Therefore, this article will discuss the condition of antepartum haemorrhage as well as the implications of it to Islamic law. This study uses a qualitative research methodology by analysing primary and secondary documents such as the classical books as well as academic writings in the journals. The findings of the study indicate that there are differences or argument regarding the implication to Islamic law and related with current issue. In addition, this article has also found that there are implications on the ibadah of parturient if the issues are not resolved due to differences of argument. Therefore, this article suggests for improvement in part of knowledge and understanding toward the issue of antepartum haemorrhage in order to ensure consistency in worship towards God.

MYOMA PLACENTA RELATIONSHIP & PREGNANCY OUTCOME

During the two years study period, 8557 deliveries took place, of which 114 were pregnancies with myoma giving the incidence as 1.33%. 12 of the 114 pregnancies ended in abortion, i.e.10.5%. The myoma placenta relationship and the obstetric outcome was analyzed in the remaining 102 pregnancies which continued beyond 22 weeks. Of these, 41.2% had complications. Premature rupture of membranes was the commonest complication seen in 22.5%. No case of preeclampsia or antepartum haemorrhage occurred in the 'no contact' category. Amongst the cases where the placenta was either in contact or superimposed on the broid, 85.5% -87.5% developed one or more complication. The myoma placenta relationship was found to be statistically signicant, p value <0.001. 39.3% were caesarean deliveries. Overall 37.25% were low birth weight neonates. There were two stillbirths, both in the superimposed category.

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

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.