Study of patients with Antepartum Haemorrhage in Wad Madani Teaching Maternity Hospital

Abstract

This study is a prospective descriptive study of antepartum haemorrhage (APH), which is one of the major obstetrical emergencies and it was associated with increased maternal and perinatal morbidity and mortality. The objectives of this study were to identify causes of APH, the risk factors, to describe the methods of diagnosis, to evaluate the management and to identify the complications (both foetal and maternal). In this way APH can be managed properly to minimize the complications. The study was done in Wad Madani Maternity Teaching Hospital (WMTH), 101 cases of APH were studied. The study population were pregnant ladies between the age of 16 to 44 years, who were presented with vaginal bleeding after 28 weeks gestational age and before the onset of labour. The study also included cases of silent placenta praevia (PP) diagnosed incidentally by ultrasound (U/S) or at the time of caesarean section (C/S). The data were collected through a questionnaire and they were entered into a master sheet. Statistical analysis was done using Statistical Package of Social Sciences (SPSS). From the study the incidence of APH during 6 month period extending from 1st December 2002 to 31st May 2003 was 4.5% related to 2215 total deliveries during this period. There were 55(54.5%) cases of PP, 29(28.7%) of abruptio placentae, 17(16.8%) cases of antepartum G haemorrhage of unknown origin (APHUO). No case of APH due to local cause or vasa praevia was reported. In this study we found that the major cause of APH was PP, and the U/S had played a major role in diagnosis of PP. Also we found that there was an increased likelihood of PP with the number of C/Ss and 21(20.8%) cases of PP had C/S before. From this study we concluded that, the PP was the major cause of APH in Wad Madani Maternity Teaching Hospital (WMTH). Also 27 cases (26.7%) with APH due to PP had a past history of surgical intervention, which include 21 cases of C/S and 6 cases of evacuation. The U/S had a beneficial role in localizing the placenta. There is an increased rate of stillbirth (23 cases) and preterm labour (37 cases), specially with abruptio placentae. Also the majority of APH cases (66 cases) were terminated by C/S (either elective C/S or emergency C/S). From this study we recommended that, family planning and spacing of deliveries should be encouraged. There should be a good antenatal care in order to select and follow up risky cases. Also medical problems like hypertension and anaemia should be managed properly. Also we recommend good referral system and communication between rural and central hospitals. Blood bank services should be improved. Surgical technique should be proper in both obstetrical and gynaecological operations with the use of prophylactic antibiotics. C/S rate should be reduced as much as possible in order to decrease the incidence of PP, and C/S for PP H should be done by an experienced obstetrician to avoid complications (both maternal and foetal).