FETO–MATERNAL OUTCOME IN CASES OF ACCIDENTAL HAEMORRHAGE

Abstract

Background: Accidental haemorrhage is a grave obstetrical emergency that refers to bleeding at the decidual-placental interface which causes placental detachment over 28 weeks of gestation age and prior to delivery of the fetus. WHO reported 2.1% maternal mortality rates due to Abruptio placenta, and the fetal perinatal mortality rate was 15% while its incidence was 0.65%. Abruption may be “revealed,” in which case blood tracks between the membranes and the decidua, and escapes through the cervix into the vagina. The less common “concealed” abruption occurs when blood accumulates behind the placenta, with no obvious external bleeding.

Aim: The study aimed to understand the incidence and predictors of adverse outcomes of Accidental hemorrhage in our setting and Knowledge from this study will help in determining the outcomes and designing management strategies improving Fetal maternal outcomes.

Methods: It was an observational prospective hospital-based study design with a follow-up component. All pregnant women diagnosed to have abruption placenta from 28 weeks of gestation and above; all babies delivered by mothers with abruptio placenta.

Result: The majority of cases 86(86%) belonged to the reproductive age group of 21-30 years. 60(60%) cases were multipara within 2-4 range of parity and 5 (5%) patients were grand multiparous. Thus the present study would tend to support multiparity as a risk factor. In the present study, higher frequency of unbooked cases 62 (62%) was seen as they were referrals, most of them had no antenatal checkups and only presented in hospital as obstetric emergencies. Majority of the cases came with complaint of bleeding per vaginum, as blood escapes out the cervix after travelling between membranes. 78% of the neonates were born alive. 70% of the patients had an APGAR score ranging from 5-10. The neonatal weights ranged from 1.0 -4.0 kg, the distribution pattern shows 48 (48%) neonates in the range 1500-2499 gms, 14 (14%) neonates in the range 1000-1499 gms and 38 (38%) neonates in the range 2500-3999 gms.

Conclusion: In light of the current study, it was found that the incidence of Accidental haemorrhage was 0.4%. The study also identified that 60% of the cases were multigravida having parity from 2-4. Furthermore, the study found that 22% of cases were stillbirth; there was 8 neonatal death contributing to increased perinatal mortality of 30%.