Management and outcomes of antepartum haemorrhage in women delivering at Harare Maternity Hospital

Abstract

Background: Antepartum haemorrhage and its complications are responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide.

Objectives: To assess the prevalence, maternal and perinatal morbidity and mortality as +well as to evaluate the management rendered to women presenting with antepartum haemorrhage who delivered at Harare hospital during the study period.

Study Design: Prospective cross sectional study carried out on 125 women recruited between August and December 2014.

Setting: Harare Maternity Hospital, Zimbabwe.

Main Outcome Measures: The study evaluated demographic data, clinical diagnosis, maternal and neonatal complications and management of antepartum haemorrhage cases.

Results: A total of 6033 deliveries were recorded and 125 had antepartum haemorrhage giving a prevalence of 2.1%. The clinical diagnosis was placental abruption 49 (39.2%), placenta praevia 44 (35.2%), indeterminate 18 (14.4%), heavy show 12 (9.6%) and ruptured uterus 2 (1.6%). Mean age was 29 years (range 17-43) and a modal parity of 2. Evaluation of management of cases revealed that insertion of large bore cannula, cross matching of blood, catheterisation were achieved in 70-80% of cases. Maternal complications included postpartum haemorrhage 50 (40%), need for transfusion 41 (32.8%) and caesarean hysterectomy 4 (3.2%). Maternal deaths, 5 (4%) were all due to placental abruption. Preterm births accounted for 44.8% of deliveries and 53.6% of the live births were admitted to neonatal unit. Stillbirths occurred in 3 (6.8%) of placenta praevia and 35 (71.4%) of placental abruption and 3 (9.4%) were due to other causes.

Conclusion: The study showed a prevalence of antepartum haemorrhage of 2.1% and considerable maternal and perinatal morbidity and mortality attributable to antepartum haemorrhage. There were gaps in adhering to the management protocol.