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Background: Grand multiparous pregnancies have been considered to be at higher risk of developing antenatal and perinatal complica?ons like pre-eclampsia, gesta?onal diabetes mellitus, anemia, antepartum hemorrhages, preterm labor, mal-presenta?on, mal-posi?on and feto-pelvic dispropor?on This study was done to know the magnitude of grand mul?para a?ending the ter?ary care center with possible complica?ons related to high parity. Objec?ves:To study the prevalence possible fetomaternal complica?ons associated with grand mul?para at rural setup. Methodology:Descrip?ve cross-sec?onal study conducted in medical college of rural area for 12 months. Grand mul?para with 5 or more deliveries before current pregnancy coming for antenatal checkup and delivery were enrolled. Antenatal history was recorded ?ll delivery and feto-maternal outcomes were noted. Results:Out of 1500 deliveries conducted during study period, 110 (7.5%) cases were grand mul?para. Majority of them (79.5%) were Muslim and 80% were anaemic. 60% delivered with FTND, and 25.4% had emergency LSCS with one intrauterine death and a single breach delivery. Predominantly preeclampsia (23.6%) and malpresenta?on (14.5%) were diagnosed as antepartum complica?ons. Almost one fi?h of them had postpartum hemorrhage which was controlled with no mortality. 13 (11.8%) grand mul?para women had s?ll birth or early neonatal death, though fetal distress was observed in 37 cases. Conclusion: Grand mul?party is s?ll a high-risk pregnancy associated with adverse maternal and fetal outcomes in our facility with mul?ple interrelated but mostly preventable causes.
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Vaginal varix during pregnancy is a rare condition that may be a concern for hemorrhage risk during childbirth.A 32yr old female G3P2L2 with NVD at 30 weeks of gestational age presented to OBG Department (Labor Room)with massive vaginal bleeding without known history of trauma nor any evidence of Placenta previa. On examination: Vital status is unstable and upon pelvic inspection- A stream of blood through a ruptured vein in vagina(Vaginal varices). Immediately vein is clamped with artery forceps and patient is stabilized by crystalloids, Dopamine, Nor-adrenaline and 4 PRBC transfusion and under short general anesthesia (ketamine) transvaginal ligation of vaginal varices is done and pregnancy is prolonged in view of threatened preterm labor( by Isoxsuprine)and terminated by 37 weeks of gestational age by EL.LSCS., Spontaneous resolution of vaginal varices occurred.
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Introduction: Abruptio placenta is a serious condition that increases maternal and neonatal morbidity and mortality. The incidence of abruption placenta is between 0.49% -1.8%. Primary cause of abruption is not known but the main precipitating and predisposing factors of abruption are age, parity, anemia, poor nutrition, pregnancy induced hypertension, eclampsia, gestational diabetes mellitus, preterm premature rupture of membrane, and previous medical termination of pregnancy. Methodology:It is a retrospective observational study done by analyzing the case sheets of abruption placenta in tertiary care hospital from January 2020 to December 2020. All those patients of antepartum hemorrhage presenting directly as typical cases of abruption placenta were included. Also, those cases in which placenta previa and other causes were ruled out after clinical, per speculum examination and/or USG examination were ruled out. Result:The total number of abruption placenta collected during this period was 21. We found 38% patients with chronic hypertension, 33 % of patients with severe preeclampsia, 14% with eclampsia, 15% were normotensive. Advanced maternal age and multiparity were also the risk factors of abruption placenta. Conclusion: Antenatal care which identifies the risk factors like PIH plays an important role in decreasing the incidence of abruption placenta. Early detection and active management will reduce morbidity.
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Background: Eclampsia is one of the leading causes of maternal mortality in India.Methods: A prospective observational study was done on 200 pregnant women admitted with antepartum eclampsia in Malda Medical College from 1 April 2017 to 30 October 2019. Group A included patients who delivered through vaginal route within 10 to 12 hrs of eclampsia by stabilisation of patients while Group B included subjects who underwent early caesarean section for uncontrolled convulsions or poor Bishop score. Maternal and perinatal outcomes were compared between the groups. Data was recorded in a pretested performa and was analyzed using appropriate statistical methods with SPSS.Results: Caesarean section (group B) was done in 130 cases (65%) while vaginal delivery (group A) was done in 65 cases (37.5%). Group A had higher maternal mortality (10.7%) in comparison to group B (4.6%) which was statistically not significant (p=0.1075). There were 32 neonatal deaths (24.6%) and 11 still births (8.46%) in group A while there were 12 neonatal deaths (18.46%) and 3 still births (4.61%) in group B. There was a statistically significant difference (p<0.0001) between the groups with respect to total perinatal deaths.Conclusions: Antenatal and intranatal eclampsia should be managed by early termination of pregnancy preferably with Caesarean section. Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.
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Background: Placenta previa is one of the major causes for obstetric hemorrhagic morbidity and mortality with increasing incidence in recent times. This study aims at determining risk factors, maternal and fetal outcome associated with placenta previa.Methods: This was an observational, retrospective study conducted at a tertiary care hospital in Mumbai from May 2017 to March 2020. A total of 102 women with placenta previa during the study period were included, their case records critically analyzed to identify risk factors, maternal outcome in relation with blood transfusion required, ICU admission, obstetric hysterectomy and fetal outcome pertaining to prematurity, asphyxia and mortality.Results: A total of 102 patients were analyzed. Placenta previa was more common in >26 years of age, multipara (64.7%), with previous history of caesarean sections (21.5%) and previous curettage (11.7%), 44.2% babies born were preterm, 4.4% stillbirths and 8.5% neonatal deaths. Maternal complications like antepartum hemorrhage was seen in 58.8% patients and postpartum hemorrhage in 33.3%, blood transfusion was required in only 18 patients post operatively, bladder rent was seen in 3 patients and there was no maternal mortality. 44 patients required uterine artery ligation, Ashok Anand stitch was taken in 37 patients, uterus compression sutures in 10, obstetric hysterectomy in 7 patients and internal iliac artery ligation in 2 patients.Conclusions: Early identification of women at risk, obstetric preparedness and simple techniques like uterine artery ligation, Ashok Anand stitch and uterine compression sutures can help in effectively reducing need for multiple blood transfusions and morbidity.
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Background: During a period of eight months, 180 cases of abruption that occurred from January 2007 to August 2007 at GMH, Nayapool, Hyderabad were analysed. Total number of deliveries during the study period of eight months were 14004. Incidence of abruption cases delivered was - 1.3%. In this series 88% were unbooked in our hospital, were referrals. Objective of this study was to study maternal fetal outcome of placental abruption.Methods: Initial clinical assessment, investigations for maternal fetal wellbeing, expedite delivery, manage complications as per accepted protocol. In this series of cases, ARM was done in 85 cases (47.22%), ARM was done and oxytocin drip was started in 36 (20%), ARM was done and PGE1 tablet 25 mcg. was inserted in the vagina in 39 (21.66%).Results: The bleeding was revealed in 146-81.1% and concealed in 34-18.88%. The number of cases with hypertension complicating pregnancy were 102-57%, hypotension in 16-8.88%, prolonged clotting time 13-7.22%, the number of patients who received blood transfusions were 105 (58.3%), number of patients who received fresh frozen plasma, FFP transfusions were 65-36.11%. Taken for LSCS at admission were - 46. Failure to progress after ARM or other methods of labour augmentation were 20 cases. The total number of caesarean deliveries were 66/180 - (36.66%), number of vaginal deliveries were 114 (63.33%). Perinatal outcome: the total number of intra uterine fetal deaths (IUFD) at admission were 103-57.2%. The number of still births were 7-3.8%. Live born babies were 70- 38.8%. Neonatal deaths were 11-6.1% and total perinatal deaths were 121-67.2%. (IUFD at admission-103, + still births - 7, + neonatal deaths - 11=121 perinatal deaths. There were five maternal deaths in 180 cases of placental abruption, 2.7% mortality.Conclusions: Need to consider measures to reduce the occurrence of this condition.
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Background: Obstetrical hemorrhage is leading cause of maternal mortality. UAE is termed safe and effective method for resolving hemorrhage. objective of this study was to determine efficacy of uterine artery ligation in management of obstetrical hemorrhage.Methods: This cross sectional observational using non-probability convenient sampling technique was carried out for six months. After ethical approval, females between 18 to 35 years diagnosed with obstetrical hemorrhage, uterine atony refractory to medical treatment, having active bleeding from placental side or having normal coagulation profile were while females with post-partum hemorrhage because of retained products of conception, due to genital tract trauma or with disseminated intravascular coagulation were excluded. Analysis of data was done using SPSS version 23.0. Quantitative variables were reported as mean and standard deviation and for qualitative variables, frequency and percentages. Chi-square test was applied keeping p-value of <0.05 as statistically significant.Results: From 109 females with mean age 47±5.25 years. In comparison of parity distribution, 62 (56.88%) were multiparous and 47 (43.12%) were primiparous. Type of bleeding observed was antepartum 36(33.03%), peripartum 39 (35.78%) and postpartum in 34 (31.19%). Efficacy of uterine artery ligation in management of obstetric hemorrhage was observed to be 35 (32.11%). The efficacy of uterine artery ligation in management of obstetric hemorrhage in three categories of age groups reported significant association (p=0.0005) and type of bleeding (p=0.025).Conclusions: Efficacy of UAE in different types of obstetrical hemorrhage reported in our study was lower than expected in about one-third of females.
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Background: Morbidly adherent placenta is associated with high maternal morbidity and mortality. Its increased prevalence seems to be proportional to the increasing number of caesarean sections. In this study the presentation and management of 32 cases was reviewed with morbidly adherent placenta and maternal and perinatal outcomes from 2014 to 2016, at the hospital.Methods: Study type was retrospective. We reviewed clinical information from patients’ case sheets regarding the risk factors, preparations prior to cesarean section, intraoperative and postoperative complications. Results were interpreted and conclusions were withdrawn.Results: Among the 32 cases, 28 were diagnosed prenatally while 4 were diagnosed intraoperatively. Out of 28 patients, 5 patients were diagnosed early between 14 and 18 weeks of gestational age and other 23 were diagnosed during third trimester by ultrasonography. Caesarean hysterectomy was required in 28 cases.4 were managed conservatively, out of which hysterectomy proved to be necessary in the postpartum period because of severe secondary postpartum hemorrhage in 2 cases. Average no of hospital stay is 10 days ranging from 8-18 days.Conclusions: Prenatal diagnosis of morbidly adherent placenta is essential to plan for the better maternal and perinatal outcome. The decision to perform a cesarean hysterectomy or conservation of uterus (using balloon tamponade or putting haemostatic sutures) is based on the extent of infiltration, the patient’s hemodynamic status, and her desire for future pregnancy. The risk of infection and severe hemorrhage remains high if conservative management is chosen and requires prolonged close monitoring postoperatively. Ideally all the cases should be electively planned and operated by senior surgeon and experienced assistants with senior anesthetist, urosurgeon and physician, with full backup of ICU and blood bank.
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Background: Placenta previa is defined as placenta that is implanted somewhere in the lower uterine segment either over or very near the internal cervical os. Placenta previa and coexistent accrete syndromes contribute substantively to maternal and perinatal morbidity and mortality.Methods: All This is a retrospective study of 88 cases of placenta previa, which were admitted under department of obstetrics and gynecology in our institute during July 2017 to June 2019. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by ultrasound examination. Outcome measures prevalence of placenta previa, maternal and neonatal outcomes, and case fatality rate.Results: The total number of deliveries performed during the study period was 16330, of them, 88 cases were placenta previa. Thus, the prevalence of PP was 0.53%. Multiparity was one of the etiological factors in 84.09%, whereas previous LSCS was 47.73%, previous H/O D and E was 14.73%, previous H/O placenta previa was 7.95%. Obstetric hysterectomy was done in 7 (7.95%) patients out of 88 patients. 92.04% of patients delivered with cesarean section and 7.95% patients delivered with normal vaginal delivery. 22 (26.50%) babies out of 83 live born were admitted in NICU.Conclusions: Advancing maternal age, multiparity, prior cesarean section, and prior abortions are independent risk factors for placenta previa. Placenta previa remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa should encourage a careful evaluation with timely delivery to reduce the associated maternal and perinatal complications. Measures to reduce the primary caesarean section rate should be adopted.
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Background: Placenta praevia is one of the serious obstetric problems with far reaching effects and a major cause of antepartum haemorrhage. The aim of the study was to evaluate the foetomaternal outcome of pregnancies with placenta praevia.Methods: The present study was a prospective case control study conducted in the Department of Obstetrics and Gynaecology, Lal Ded Hospital, Srinagar from August 2009 to October 2010.Results: Among the 100 cases of placenta praevia studied bleeding per vaginum was the most common presenting symptom. Major placenta praevia was more common (53%) than minor placenta praevia. 43% of the cases of placenta praevia delivered before 37 completed weeks as compared to only 6% in the control group. All cases of placenta praevia delivered by caesarean section. Maternal morbidity in terms of postpartum haemorrhage (32%), intraoperative bowel and bladder injury (2%) and intensive care unit admission (1%) was more in cases of placenta praevia. Foetal complications in terms of neonatal intensive care unit admission (19%), neonatal death (10%) and stillbirth (5%) were more in pregnancies with placenta praevia as compared to controls. 48% of patients with placenta praevia required transfusion of blood and blood products as compared to 4.5% among controls.Conclusions: There is a significant increase in maternal morbidity in pregnancies complicated with placenta praevia. Also, there is a higher incidence of foetal complications and neonatal death. Managing a case of placenta praevia is a challenge in present day obstetrics and it creates a huge burden on the health care system.
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Background: Antepartum haemorrhage (APH) as one of the major obstetric emergencies contributing greatly to maternal and fetal morbidity and mortality is of serious concern in the developing world. A retrospective analysis of the APH cases and evaluation of its impact on fetal and maternal outcomes was conducted.Methods: A retrospective study of cases managed between January 2013 and December 2014 at the University College Hospital Ibadan; all cases at a minimum of 28 weeks of gestation with antepartum bleeding were selected. Data was retrieved from the hospital records.Results: Around 5.8% prevalence rate of APH was documented during the study period with placental abruption and placenta praevia accounting for 46.8% and 39.2% of these cases respectively. Only 28.5% of cases were booked. Three-fifths of the women had anemia, 17.7% suffered hypovolemic shock, 33.9% also had primary PPH while 4 out of every 10 (39.8%) were transfused with blood. Seven out of every ten premature deliveries (prior to 34weeks gestation) were due to placental abruption with p value of <0.001. There were 2 maternal deaths (1%), 61 (31%) still births and 11 (5.6%) early neonatal deaths giving a perinatal mortality rate of 35.6%.Conclusions: Antepartum hemorrhage was associated with poor maternal and neonatal outcome in this study. There is need to improve on infrastructures, such as functional blood banks, appropriate antenatal care and referral system in our health facilities to be able to cope with increasing challenges of this obstetric hemorrhage.
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Background: Obstetric haemorrhage is the leading cause of preventable maternal mortality worldwide. One of the major contributors to obstetric haemorrhage is antepartum haemorrhage which is mainly caused by placenta praevia and abruptio placenta. The study aims to quantify the risk of placenta praevia based on the presence and number of caesarean sections and to assess other risk factors.Methods: This study was a prospective case control study conducted in the department of obstetrics and gynecology, Lalla Ded hospital, Srinagar, Jammu and Kashmir, India from August 2009 to October 2010. As per the inclusion and exclusion criteria of study 100 cases and 200 controls were selected and the association of placenta praevia with proposed risk factors was analysed statistically.Results: Present study showed that the risk of developing placenta praevia in future pregnancy increased steadily as the number of previous caesarean sections increased, risk being 2.1, 2.8 and 4 times with previous one, two and three caesarean deliveries respectively. Similarly, the risk of developing placenta praevia was more in women with history of previous abortion (risk being 2.8 and 6.5 times more in women with one and two abortions in the past). Previous dilatation and curettage and age more than 30 years also proved to be independent risk factors.Conclusions: To conclude advanced maternal age, previous abortion, dilatation and curettage and a history of previous caesarean section appear to increase the occurrence of placenta praevia. The study strongly emphasises the need to decrease the primary caesarean section rate.
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Background: Maternal age is an important determinant of the outcome of pregnancy. Advanced maternal age generally signify age after 35 years at the time of delivery. It is associated with decreased fertility and increased risk. Elderly gravida is associated with many complications during pregnancy, labour and also for the baby. In recent times women has changed their lifestyles such as pursuit of higher education and entry into work forces and career advancement outside the home.Methods: This was a retrospective study done in 57 elderly pregnant women more than 33 years age, over a period of 18 months, conducted in a multi-specialty hospital.Results: 57 elderly pregnant women were selected for the study. 47% were in age group of 33-35 years and 42% were in age group of 36-40 years. 61.40% patients were housewives and 38.59% were employed. 50.8% of patients had history of previous abortions and 35% were conceived after treatment for sterility. 64.9% of patients conceived spontaneously and 35% by assisted reproductive technology. Majority of patients (33.3%) required Invitro-fertilization. Multiple pregnancy was high- 21.05%. Hypertension was observed in 26.3% of patients, Antepartum haemorrhage in 4.34%, Preterm delivery 49.1%, Induction of labour in 10.52%, Normal vaginal delivery only in14%. Majority of patients (80.7%) were delivered by caesarean section.Conclusions: Elderly pregnant patients have higher risks of specific pregnancy complications which contribute to a higher frequency of maternal morbidity and greater health care costs. The risks are due to Hypertension, diabetes, multiple pregnancy, preterm labour, antepartum haemorrhage, PROM, malpresentation, prolonged labour, increased caesarean section rate and postpartum haemorrhage.
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Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications.
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Background: The incidence of placenta previa ranges from 0.5-1% amongst hospital deliveries. Placenta previa is major cause of antepartum haemorrhage and is potentially devastating complication. Obstetric haemorrhage is most common cause for maternal and perinatal morbidity and mortality in India. This study aimed to determine frequency, type of placenta previa, risk factors and adverse fetomaternal outcomes of placenta previa.Methods: This was a prospective study carried out in Department of Obstetrics and Gynaecology, Government Medical College and Sir-T hospital, Bhavnagar from July 2007 to July 2009 to analyze fetomaternal outcome in cases of placenta previa. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by Ultrasound examination. All cases were carefully analyzed to find out the incidence, type of placenta previa, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity.Results: There was total 50 cases of placenta previa out of 5636 deliveries. The prevalence of placenta previa was 0.88% and was more commonly present among multiparous women (82%). Most common type was type IV placenta previa in 23 (46%) cases followed by type III in 11 (22%) cases. Out of 50 cases, 06 (12%) cases had atonic PPH and 02 (04%) cases underwent peripartum hysterectomy. Most common predisposing factors were age >35 years (04%), multiparity (50%), previous cesarean section (16%) and previous history of abortion (12%). All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.5 kg. There was no maternal mortality in this study.Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due to its increased risk of maternal and perinatal complications.
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Introducción: la hemorragia obstétrica es la segunda causa más frecuente de mortalidad materna en el Ecuador, a pesar de ello, es un tema que se ha estudiado poco a nivel provincial y nacional. Objetivo: determinar la ocurrencia e identificar los factores de riesgo, manifestaciones clínicas y comorbilidades más frecuentes de la hemorragia de la segunda mital del embarazo. Métodos: estudio descriptivo, transversal, donde se analizaron las historias clínicas de las pacientes obstétricas con hemorragia de la segunda mitad del embarazo atendidas en el Hospital Provincial General Docente Riobamba (HPGDR) entre junio 2017 y junio 2018. Resultados: de un total de 3 460 pacientes obstétricas atendidas, 0.49% (n = 17) cumplieron los criterios de hemorragia en la segunda mital del embarazo, las cuales tuvieron una edad media de 29 años (desviación estándar = 7), una edad gestacional media de 36 semanas (desviación estándar = 5) y en su mayoría fueron multíparas. El desprendimiento de placenta normoinserta fue la principal patología causante de la hemorragia y el dolor abdominal el principal síntoma manifestado, en la mayoría no se observó otras comorbilidades obstétricas. Conclusión: se observó una baja ocurrencia de hemorragia de la segunda mitad del embarazo en el HGDR entre junio 2017 y junio 2018, siendo la causa más frecuente el desprendimiento de placenta normoinserta y el principal mitivo de consulta dolor abdominal.
Introduction: obstetric hemorrhage is the second most frequent cause of maternal mortality in Ecuador. Nevertheless, the topic has been little studied at a local and national level. Objective: to determine the ocurrence and identify the most frequent risk factors, clinical manifestations and comorbilities in antepartum hemorrhage. Methods: it is a descriptive, cross-sectional study, in which clinical histories of obstetric patients with hemorrhage of the second half of pregnancy were analyzed in the Hospital Provincial General Docente Riobamba (HGPDR) between June 2017 and June 2018. Results: from 3 460 obstetric patients attended, 0.49% (n = 17) met antepartum hemorrhage criteria. Women were in average 29 years old (standard deviation = 7), had an average gestational age of 36 weeks (standard deviation = 5) and were multiparous. Detachment of normoinserta placenta was the main cause of bleeding, abdominal pain was the most frequent symptom reported and in the majority of cases no obstetric comorbilities were observed. Conclusions: it was observed a low ocurrence of hemorrhage of the second half of pregnancy in the HGDR between June 2017 and June 2018. The mots common cause of the patology was detachment of normoinserta placenta and the most frequent complain reported was abdominal pain.
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Humans , Female , Pregnancy , Adult , Middle Aged , Pregnancy Trimester, Second , Uterine Hemorrhage , Risk Factors , Pregnancy Trimester, Third , Signs and Symptoms , Maternal Mortality , EcuadorABSTRACT
Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.Methods: A sample size of 200 normal delivered patients between age group 18 and 45 years is chosen with excessive bleeding after third stage of labour and after administration of oxytocics. These 200 patients are divided into two groups: First group receiving Misoprostol and applying condom catheter in other group. Both groups are evaluated for PPH.Results: It was found that CG balloon condom catheter was a much better and more effective alternative in controlling PPH than Misoprostol as the failure rate with CG balloon condom catheter were much less than that with misoprostol. Due to its cost effectiveness and being easily available at primary health center and due to absence of any drug reactions and easy technique of formation makes it a better modality in controlling PPH even at PHC.Conclusions: Patients with condom catheter in situ must show better result than patients receiving misoprostol.
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Background: Antepartum haemorrhage is one of the important causes of perinatal mortality and morbidity in India. The increased risk of perinatal morbidity and mortality in placenta praevia is due to preterm birth, low birth weight, birth asphyxia and neonatal sepsis. This is a retrospective study done over a period of 5years to determine the incidence, demographic features, risk factors, obstetric management, maternal mortality and morbidity, and perinatal outcome in women presenting with placenta praevia.Methods: This was a retrospective study done at Nil Ratan Sircar Medical College and Hospital over a period of five years starting from January 2016 to December 2017. Antenatal women with more than 28 weeks of gestational age with a complaint of painless vaginal bleeding or those diagnosed as having placenta praevia on routine ultrasound examination were included in this study and hospitalised. Among them cases of placenta praevia were 21.Results: There were21 cases of placenta praevia registered amounting to 0.23% incidence. The various antenatal complications seen associated with placenta praevia were severe anaemia (14.28%), coexisting PIH (4.76%), IUD (4.76%), IUGR/Oligohydraminos (4.76%). All the patients in the study had undergone caesarean deliveries. Perinatal morbidity studied as percentage of new-borns requiring resuscitation followed by NICU admission was 33.3%. Among the delivered patients of placenta praevia incidence of perinatal mortality was 23.8%. Prematurity (42.85%) contributed to most cases of perinatal mortality, followed by RDS (14.28%) and asphyxia (14.28%).Conclusions: In this study placenta praevia is seen more commonly in 28-34 weeks of gestation and patients mainly presented with a bout of bleeding eventually had preterm deliveries. Although vaginal deliveries are appropriate in selected cases of placenta paevia liberal use of caesarean section in well-equipped hospitals with availability of blood transfusion services have helped to lower complications.
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OBJECTIVE: To study the effect of antepartum haemorrhage on pregnancy outcomes in placenta previa cases.METHODS: A total of 404 cases of placenta previa in the First Affiliated Hospital of Nanjing Medical University from Oc-tober 2012 to December 2017 were compared. The high-risk factors of prenatal hemorrhage were analyzed,and pregnan-cy outcomes were compared between no-bleeding group(n=254)and repeated-bleeding group(n=150).RESULTS: Uni-variate Logistic regression analysis suggested:when the number of gravidity and uterine cavity operation reached 3 times,prenatal bleeding risk was higher than those less than 3 times(OR=1.937,95%CI 1.054-3.562;OR=2.174,95%CI1.050-4.504),respectively.The risk of prenatal hemorrhage was the highest at 28-<32 weeks of gestation,and the riskof of prenatal bleeding decreased with the increase of gestational weeks.The risk of prenatal hemorrhage in patients withplacenta previa was higher than that in patients with posterior wall placenta(OR=3.978,95%CI 2.220-7.195).The riskof prenatal hemorrhage in women with central placenta previa was higher than that in women with marginal or partial pla-centa(OR=3.346,95%CI 2.050-5.460).Multivariate Logistic regression analysis suggested:the risk of recurrent prenatalbleeding in central placenta previa was higher than that in marginal and partial ones(OR=3.344,95%CI 1.955-5.722).The risk of prenatal bleeding in placenta previa was higher than that in posterior wall placenta(OR=3.954,95%CI 2.196-7.387).The risk of prenatal bleeding was significantly re-duced at ≥36 weeks of gestation,and the risk was signifi-cantly lower than that at other gestational weeks(OR=0.086,95% CI 0.030-0.240).The emergency operationrisk of pregnant women with repeated prenatal hemor-rhage was higher than that of those without prenatal hemorrhage(OR=252,95%CI 60.173-1055.359),and the risk of using blood products was higher than no-bleeding group(OR=2.103,95%CI 1.394-3.171).Compared with women in no-bleeding group,the risk of low birth weight,and mildand severe asphyxia of the newborn increased(OR=7.982,95%CI 2.410-26.426),(OR=2.987,95%CI 1.529-5.837)and(OR=13.941,95%CI 1.690-114.626),respectively,and the risk of admission and treatment in neonatal intensive careunit(NICU)was increased in repeated-bleeding group(OR=3.379,95%CI 2.102-5.430).CONCLUSION: The risk factorsof prenatal haemorrhage of placenta previa are gravidity,uterine cavity operation,gestational weeks at termination ofpregnancy,and placental type and position;central placenta and anterior placenta are independent risk factors for in-creasing prenatal bleeding;repeated prenatal bleeding increases the risk of using blood products,low birth weight of thenewborn,neonatal asphyxia and neonatal NICU admission.
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Background: The Objectives of the present study are to assess the risk factors associated with antepartum haemorrhage (APH), maternal morbidity & mortality due to APH and its perinatal outcome in APH. Methods: This study was an analytical retrospective study conducted at NIMS University and Medical College, Jaipur over the duration of one year from July 2013-July 2014 over 100 cases of APH admitted in the hospital. Results: Among the 100 cases of APH the types observed were, placenta praevia: 39, abruptio placenta: 31, indeterminate causes: 25 and extra placental causes: 5. Maternal mortality out of 39 cases of placenta praevia was 1 and out of 31 cases of abruptio placentae was again 1. Perinatal mortality was 10% in placenta praevia and 19% in abruptio placentae. Conclusipn: APH is a major cause of maternal and perinatal mortality & morbidity, which can be prevented, by early registration, regular antenatal care, early detection of high-risk cases, early referral, better blood bank and OT facilities, improved intra-operative and postoperative care and better neonatal intensive care.