An 8 year clinical review of antepartum haemorrhage at the University of Maiduguri Teaching Hospital, Maiduguri .

Abstract

Background: Antepartum haemorrhage is one of the obstetric emergencies associated with increased maternal and perinatal morbidity and mortality.

Objective: To determine the incidence, types, predisposing factors, complications and outcome of antepartum haemorrhage.

Methodology: A retrospective study of cases of antepartum haemorrhage over an 8 year period from January 1999 to December 2006 at the University of Maiduguri Teaching Hospital was carried out.

Results: The incidence of antepartum haemorrhage was 1.6% (248/15512), while that of placenta praevia and placental abruption were 0.8% and 0.7% respectively. Typically, placenta praevia was detected early in the pregnancy as low lying placenta in 42(36.8%) of cases, while lower abdominal pain, uterine tenderness and woody hard uterus was found in 88(89.8%), 88(85.4%) and 68(69.4%) of cases of placental abruption respectively. The predisposing factors for antepartum haemorrhage were; increasing maternal age, multiparity, previous abortion, previous uterine instrumentation and uterine scar. Threatened abortion in the index pregnancy was associated with placenta praevia while maternal hypertension was associated with placental abruption. The first bleeding episode occurred intrapartum in 74(34.9%) of patients with APH and the majority of them (57 out of 74) had placental abruption. The commonest mode of delivery was caesarean section, which accounted for 135(63.7%) deliveries and 73.3% of these were patients with placenta praevia. Seventy seven women delivered vaginally and 80.5% of them were patients with placental abruption. Preterm labour and post partum haemorrhage were the most common maternal complications while prematurity and increased perinatal mortality were the most common fetal complications. The perinatal mortality was 85(40.1%). There was no maternal mortality from this series.

Conclusion: Antepartum haemorrhage is an obstetric emergency associated with increased maternal and perinatal morbidity and mortality unless prompt resuscitative measures and appropriate treatment are offered. Early booking, appropriate referral of high risk patients and routine ultrasound scanning for placental localization are advocated for early diagnosis and optimum maternal and fetal outcomes.