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Hagos Hailu Girmatsion Fisseha Gelila Goba Hale Teka Sumeya Ahmed Awol Yemane https://orcid.org/0000-0001-8271-2447

Abstract

Introduction: The leading cause of maternal mortality in world is obstetric hemorrhage. Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. Placenta previa and Abruptio placenta are the two major causes of antepartum hemorrhage worldwide including Ethiopia, and contribute significantly to obstetric hemorrhage which is the most common cause of maternal death in developing countries like Ethiopia. Hence, the present study is planned to assess the incidence, associated factors and outcomes of APH at ACSH and Mekelle general hospital.


Objective:  To assess incidence, associated factors and outcomes of APH at Ayder comprehensive specialized hospital and Mekelle general hospital, Mekelle, Tigray, Ethiopia


Methodology: Hospital based prospective cross sectional (observational) was carried out at Ayder comprehensive specialized hospital and Mekelle general hospital over a period of 6 months from February 01, 2018 to July 30, 2018 on all pregnant mothers who were admitted to labor and maternity ward with the diagnosis of antepartum hemorrhage.


Results: There were a total of 5368 deliveries in both Ayder comprehensive specialized hospital and Mekelle general hospital over a period of six months between February, 1/2018 to July, 30/2018. During this period, 192 mothers were diagnosed to have APH making incidence of 3.8 %. The major causes of APH were abruptio placenta in 89 (46.5 %) and placenta previa in 64 (33.3 %). Anemia and PPH were the main maternal complications, each accounting for 98(51 %) and 25 (13 %) respectively. There was one maternal death (0.5 %). Of the total 200 newborns, 26 (13 %) were stillbirth and there were 19 (9.5 %) of early neonatal deaths that died in the first seven days of life after admission to NICU making PMR of 22.5 %.


Conclusion: APH which is primarily caused by abruptio placenta and placenta previa significantly affects the maternal and perinatal outcomes ACSH and MGH compared to reports from other countries. Maternal address out of Mekelle, severe maternal anemia, and abruptio placenta are predictors of increased perinatal mortality.

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Keywords

APH, Placenta Previa, Abruptio Placentae, Maternal Mortality, ACSH, Mekelle, Ethiopia

References
1. Arora R, Devi U, Majumdar K. Perinatal mortality in antepartum hemorrhage. J Obstet., 2001; 51(3): 102-4.
2. Green JR. Placental abnormalities: Placenta previa and abruption placenta, maternal & fetal medicine. In: Creasy RK, Resnik R editors Principles and Practice 3rd edition. Philadelphia, WBSaunders, 1989; 588-602.
3. Mishra R. Ian Donald’s Practical Obstetric Problems. Seventh edition. LWW. 2014. pp. 315-328.
4. Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging. Journal of Ultrasound in Medicine. 2014 May 1; 33(5):745-57.
5. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ER, Driscoll DA, Berghella V, Grobman WA. Obstetrics: Normal and Problem Pregnancies E-Book. Elsevier Health Sciences; 2016 Mar 18.
6. Mastrolia SA, Baumfeld Y, Loverro G, Yohai D, Hershkovitz R, Weintraub AY. Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study. The Journal of Maternal-Fetal & Neonatal Medicine. 2016 Nov 1; 29(21):3467-71.
7. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. The Journal of Maternal-Fetal & Neonatal Medicine. 2003 Jan 1; 13(3):175-90.
8. Tyagi P, Yadav N, Sinha P, Gupta U. Study of antepartum hemorrhage and its maternal and perinatal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2016 Dec 14; 5(11):3972-7.
9. Ghaheh HS, Feizi A, Mousavi M, Sohrabi D, Mesghari L, Hosseini Z. Risk factors of placental abruption. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2013 May; 18(5):422.
10. Ayushma J, Anjali K. Study of obstetric outcome in antepartum hemorrhage. Panacea Journal of Medical Sciences. 2015 Dec 18; 5(3):153-7.
11. Central Statistical Agency (CSA) [Ethiopia] and ICF. 2016. Ethiopia Demographic and Health Survey 2016: Key Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA. CSA and ICF.
12. Neonatal WH. Country, regional and global estimates. Geneva, Switzerland: World Health Organization. 2006.
13. Central Statistical Agency, ICF International. Ethiopia Demographic and Health Survey 2011. 2012.
14. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global health. 2014 Jun;2(6):e323-33.PubMed PMID: 25103301
15. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006 Apr 1; 367(9516):1066-74. PubMed PMID: 16581405.
16. Gaym A. Maternal mortality studies in Ethiopia--magnitude, causes and trends. Ethiopian medical journal. 2009 Jan; 47(2):95-108. PubMed PMID: 19743789.
17. Ngoc NT, Merialdi M, Abdel-Aleem H, Carroli G, Purwar M, Zavaleta N, et al. Causes of stillbirths and early neonatal deaths: data from 7993 pregnancies in six developing countries. Bulletin of the World Health Organization. 2006 Sep; 84(9):699-705. PubMed PMID: 17128339. PubMed Central PMCID: 2627466.
18. G. Sharmila, Prasanna. Maternal and perinatal outcome in antepartum hemorrhage. IAIM, 2016; 3(9): 148-160
19. Singhal S, Nymphaea NS, Nanda S. Maternal and perinatal outcome in antepartum hemorrhage: A study at a tertiary care referral institute. Internet J Gynecol Obstet. 2008;9(2):5580
20. Samal SK, Rathod S, Rani R, Ghose S. Maternal and perinatal outcomes in cases of antepartum hemorrhage: a 3-year observational study in a tertiary care hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Feb 19; 6(3):1025-9.
21. Takai IU, Sayyadi BM, Galadanci HS. Antepartum hemorrhage: A retrospective analysis from a northern Nigerian teaching hospital. International Journal of Applied and Basic Medical Research. 2017 Apr; 7(2):112.
22. Tikkanem M, Nuutila M, Hiilesma V, Paavonen J, Ylikorkala O.Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand, 2006. 85:700
23. Chufamo N, Segni H, Alemayehu YK. Incidence, contributing factors and outcomes of antepartum hemorrhage in Jimma University Specialized Hospital, Southwest Ethiopia. Universal Journal of Public Health. 2015 Jul; 3(4):153-9.
24. Hendricks MS, Chow YH, Bhagavath B, Singh K. Previous Caesarean Section and Abortion as Risk Factors for Developing Placenta Previa. J. Obstet. Gynaecol. Res.Vol. 25, No. 2: 137-142 1999.
25. Chufamo N, Segni H, Alemayehu YK. Incidence, contributing factors and outcomes of antepartum hemorrhage in Jimma University Specialized Hospital, Southwest Ethiopia. Universal Journal of Public Health. 2015 Jul; 3(4):153-9.
26. Boisrame T, Sananes N, Fritz G, Boudier E, Viville B, Aissi G, et al. [Abruptio placentae. Diagnosis, management and maternal-fetal prognosis: a retrospective study of 100 cases]. Gynecologie, obstetrique & fertilite. 2014 Feb; 42(2):78-83. PubMed PMID: 24309032. Hematome retroplacentaire. Diagnostic, prise en charge et prognostic maternofoetal: etude retrospective de 100 cas.
27. Siddiqui SA, Tariq G, Soomro N, Sheikh A, Shabih-ul-Hasnain F, Memon KA. Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae. Journal of the College of Physicians and Surgeons Pakistan. 2011 Feb 1; 21(2):79-83.
28. Lam CM, Wong SF. Risk factors for preterm delivery in women with placenta previa and antepartum hemorrhage: retrospective study. Hong Kong Med J. 2002 Jun;8(3):163-6
29. Siddiqui SA, Tariq G, Soomro N, Sheikh A, Shabih-ul-Hasnain F, Memon KA. Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae. Journal of the College of Physicians and Surgeons Pakistan. 2011 Feb 1; 21(2):79-83.
30. G. Sharmila, Prasanna. Maternal and perinatal outcome in antepartum hemorrhage. IAIM, 2016; 3(9): 148-160
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