Increasing Prevalence of Antepartum Hemorrhage “A Preventable Cause of Adverse Maternal and Fetal Outcome”: Clinical Audit on Antepartum Hemorrhage and Role of CCU in Optimizing Maternal Outcome in a Tertiary Care Hospital in North India

Introduction: Antepartum hemorrhage (APH) is a life-threatening emergency and a leading cause of maternal and perinatal morbidity and mortality.Objective: To determine the prevalence, etiology, sociodemographic characteristics, associated risk factors, and maternal and fetal outcome in patients of antepartum hemorrhage (APH).Materials and methods: One-year retrospective study was done by the Department of Obstetrics and Gynecology, KGMU, Lucknow.All patients admitted with a diagnosis of APH were included.Data were retrieved from case sheets and hospital delivery registers.Results: Total deliveries were 9404, and 711 cases of APH were recorded.The institutional prevalence rate was 7.5%.Around 53.6% of cases were due to abnormal placental locations, 46% were due to abruptio placentae, and 0.4% were due to other causes.Around 69% of cases of abnormal placental location were of placenta previa and 31% were of low-lying placenta.Age difference in the two groups was statistically insignificant, while there was a significant difference in parity and booking status.Mean gestational age at the time of termination of pregnancy was 34.3 2.3 weeks.Emergency primary LSCS was the commonest and statistically significant mode of delivery.Around 42% of patients had anemia and 17.3% had severe anemia.Around 4.3% of patients presented with hemorrhagic shock, 3.2% had DIC, and 2.7% were in ARF.Fetal complications like preterm birth, intrauterine growth restriction (IUGR), low birth weight (LBW), and neonatal unit (NNU) admissions were 65, 16, 46, and 12%, respectively.There were 40 morbidly adherent placenta and 40 cesarean hysterectomies for the same maternal mortality was 1.1%.Conclusion: Early diagnosis, advanced obstetrical care, and a multidisciplinary approach in cases of maternal hemorrhage can reduce maternal and perinatal mortality.