Antepartum hemorrhage (APH) is a critical obstetric emergency that affects 3-5% of pregnancies and is a major cause of maternal mortality (30-50%). It is characterized by bleeding from the genital tract after the period of viability (after 28 weeks in India and 24 weeks in Western countries) but before the end of the second stage of labor. APH can be categorized based on blood loss into minor (1000 ml) hemorrhage.
The primary maternal causes include placental bleeding such as placenta previa (35%) and abruptio placenta (35%), with other causes like cervical trauma, infections, and uterine rupture. Fetal causes include rare conditions like vasa previa (<1%). Miscellaneous causes include anomalies in the placenta and umbilical cord, such as circumvallate placenta and velamentous cord insertion. Placenta previa is characterized by low implantation of the blastocyst and is influenced by factors like increased parity, advanced maternal age, multiple pregnancies, and previous uterine procedures or cesarean sections. Smoking and certain placental abnormalities are also associated with its occurrence. Placenta accreta is more common in women with placenta praevia. Diagnosis involves ultrasound, Color Doppler, and sometimes MRI, but none are fully reliable.
APH complications include anemia, preterm labor, cesarean section, and various fetal risks like low birth weight and Intrauterine Fetal Death (IUFD). Aggressive management, including early detection, regular antenatal care, and timely intervention, can reduce maternal and perinatal morbidity and mortality. Improved diagnostic techniques, obstetric care, and neonatal support have significantly contributed to better outcomes. Preventive measures include early registration, antenatal care, and early referral to higher centers. A prospective observational study was conducted on 140 cases in the Department of Obstetrics and Gynecology, associated with Lala Lajpat Rai Memorial Medical College, Meerut from 1 November 2022 to 30 October 2023.
The study group primarily consisted of younger adults, with 47.14% aged between 26-30 years, and a significant portion from lower socio-economic backgrounds, with 66.67% falling into this category. A notable 65% of participants were multigravida, indicating a prevalence of experienced mothers. Emergency LSCS was the predominant mode of delivery, performed in 70% of cases, while 58% required blood transfusions, reflecting substantial intervention needs. Maternal morbidity was high (91%), though maternal mortality remained low (2%). Most participants (93.57%) were unbooked, suggesting low prenatal care, and 52.14% were illiterate. Placenta previa was the most frequent cause of APH, seen in 57% of cases. The study revealed significant neonatal morbidity and mortality, with 50.7% of newborns requiring NICU admission and 5.2% being stillborn.
The study highlighted that antepartum hemorrhage, primarily caused by Placenta Praevia, is associated with significant maternal and neonatal morbidity. High rates of emergency cesarean sections, blood transfusions, and neonatal complications like NICU admissions were observed. Low socioeconomic status, poor prenatal care, and education levels were prevalent risk factors. Improved antenatal care, early diagnosis, and timely interventions are crucial to better managing APH cases and improving outcomes for both mother and child.
Source: Verma and Parveen / Indian Journal of Obstetrics and Gynecology Research 2025;12(3):480–486
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