The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH ‐21st Project
Jane E. HirstJosé VillarCésar G. VictoraAris T. PapageorghiouD FinktonFernando C. BarrosMG GravettFrancesca GiulianiManorama PurwarIO FrederickRan PangLeila Cheikh IsmailAnn LambertWilliam StonesYA JafferDG AltmanJ. Alison NobleE. OhumaSidney H. KennedyZulfiqar A Bhutta
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Abstract:
To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care.Population-based, prospective, observational study.Eight international urban populations.Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies.Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour.Of 60 121 babies, 553 were stillborn (9.2 per 1000 births), of which 445 were antepartum deaths (7.4 per 1000 births). After adjustment for site, risk factors were low socio-economic status, hazard ratio (HR): 1.6 (95% CI, 1.2-2.1); single marital status, HR 2.0 (95% CI, 1.4-2.8); age ≥40 years, HR 2.2 (95% CI, 1.4-3.7); essential hypertension, HR 4.0 (95% CI, 2.7-5.9); HIV/AIDS, HR 4.3 (95% CI, 2.0-9.1); pre-eclampsia, HR 1.6 (95% CI, 1.1-3.8); multiple pregnancy, HR 3.3 (95% CI, 2.0-5.6); and antepartum haemorrhage, HR 3.3 (95% CI, 2.5-4.5). Birth weight <3rd centile was associated with antepartum stillbirth [HR, 4.6 (95% CI, 3.4-6.2)]. The greatest risk was seen in babies not suspected to have been growth restricted antenatally, with an HR of 5.0 (95% CI, 3.6-7.0). The population-attributable risk of antepartum death associated with small-for-gestational-age neonates diagnosed at birth was 11%.Antepartum stillbirth is a complex syndrome associated with several risk factors. Although small babies are at higher risk, current growth restriction detection strategies only modestly reduced the rate of stillbirth.International stillbirth study finds individual risks poor predictors of death but combinations promising.Keywords:
Antepartum hemorrhage
Antepartum haemorrhage
Antepartum hemorrhage is an emergency, which happened around 3% of all births, the causes include placenta previa, placental abruption, and bleeding unclear source. Predisposing factors which may result in antepartum hemorrhage include age, parity, history Sectio Cesaria (SC) and malnutrition. Antepartum haemorrhage cases in hospitals Margono Soekarjo Purwokerto increase from the year 2013 by 10.61% to 11.96% in 2014. Objective: To analyze the relationship between age, parity, history of SC and malnutrition with the incidence of antepartum haemorrhage and analyze the most influential factor the antepartum haemorrhage. Methods: This type of survey research analytic, retrospective case control approach. The population was all pregnant women undergo antepartum haemorrhage as many as 170 people and have not experienced antepartum bleeding as much as 1251 people. The samples were 63 as the case group and 63 as control group were taken Systematic Random Sampling. Bivariate analysis used Chi-square test. RESULTS: Most of age didn’t risk as much as 75 (59.5%), parity didn’t risk as much as 70 (55.6%), didn’t have a history of Cesaria sectio 75 (59.5%) and malnutrition as many as 66 (52, 4%). There was a relationship between age, parity, history of SC and malnutrition with antepartum haemorrhage with a p-value: 0.002, 0.001, 0.006 and 0.013. Age and parity is the factor most affecting antepartum haemorrhage with odds ratio: 3.29 and 3.17. Conclusion: There was a relationship between age, parity, history of SC and malnutrition with antepartum hemorrhage, the most influential factor to the incidence of antepartum haemorrhage are age and parity. Keywords: age, parity, history of SC, malnutrition, antepartum haemorrhage
Antepartum hemorrhage
Antepartum haemorrhage
Placenta previa
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Background: Globally, maternal mortality is decreasing, but in developing countries, especially Sub-Saharan Africa, maternal death has remained high. Antepartum haemorrhage (APH), which is the per-vaginal bleeding after 28 weeks of gestation and before delivery complicates 2-5% of pregnancies. Although timely access to quality obstetric services, availability of trained health service providers, availability of transfusion products, theatre waiting time are major determinants of both maternal and new-born outcomes after antepartum haemorrhage, the impact of the health system and health provider related factors associated with APH on the neonatal and maternal outcomes remains to be investigated. As such, this study evaluated the influence of health system factors on maternal and neonatal outcomes among women presenting with Antepartum haemorrhage at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Kisumu County, Kenya. Methods: The study was a prospective case-control study that recruited mothers (n=63) presenting at the maternity department with antepartum haemorrhage. The control group comprised of mothers (n=63) presenting without antepartum haemorrhage at the same maternity. The study took a period of one year. Data was coded and analysed by SPSS program version 23.0 and STATA version 14.0. Results: Abruptio placentae and placenta Previa were the major causes of APH recorded in 17 (27%) and 39 (61.9%) of APH patients, respectively. A large proportion of patients presenting with antepartum haemorrhage (APH) were younger, aged between 20-29 years (n=37, 58.7%), with an overall mean age of 26.22. Cases with APH had a lower mean parity (1.17), while controls had a higher mean parity (2.97 Caesarean section rate was high among pregnant women who had APH (n=42, 66.7%). (p=0.001). Out of these, 32 (52.4%) were done as emergency. Majority of the emergency caesarean sections were done within 30 minutes from the time the decision to deliver had been made (n=17, 54.8%). Most patients who presented with APH were referred from another facility (n=42 (66.7%) in our study. Risks of perinatal and maternal mortality were higher for patients who came from outside of JOOTRH compared to patients from JOOTRH (OR=3.16, 95%CI=1.34-5.57, P< 0.0001). High risks of perinatal mortality (19.9%) and maternal mortality (3.2%) were observed among APH patients in our study hospital compared to mothers who did not experience APH (8% and 0% respectively). Majority of new-borns of patients who had APH were admitted to NBU (n=42, 66.7%) (p=0.017) and the major reason for admission to NBU was prematurity and low Apgar score. Conclusion of the study is that APH is a major cause of maternal and perinatal morbidity and mortality. This could be prevented by regular and focused antenatal care, early detection of risk factors and prompt referrals. Many facilities for caesarean sections, availability of blood banks and blood transfusion products, facilities with ICU and proper new-born units with adequate staffing can improve maternal and perinatal outcome of patients with APH
Antepartum haemorrhage
Antepartum hemorrhage
Placenta previa
Obstructed labour
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A triplet pregnancy is described in which there was a second trimester abortion of one fetus at 16 weeks' gestation. A cervical cerclage was placed, and tocolysis was used. The other two triplets were delivered 131 days later (at 35 weeks' gestation) by cesarean section. Both infants survived. This case is unique in the literature.
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Antepartum bleeding is vaginal bleeding in pregnancy over 28 weeks or more. Because antepartum bleeding occurs at gestational age above 28 weeks, it is often called or classified as bleeding in the third trimester (Manuaba, 2007) while postpartum hemorrhage according to the World Health Organization (WHO) in 2006, namely partly puerperal blood loss of 500 ml or more that occurs after the child is born. The purpose of this study was to find out the characteristics of mothers who experienced antepartum bleeding and postpartum hemorrhage at Efarina Etaham Berastagi Hospital in the 2013-2016 period. The type of research used in this study is a retrospective descriptive study. The population in this study were medical records of mothers who experienced antepartum and postpartum hemorrhage at Efarina Etaham Berastagi Hospital, Karo District in 2013 - 2016. The number of medical records of mothers who experienced antepartum hemorrhage was 17 cases of antepartum and 25 cases of postpartum hemorrhage. From the results of a study on the characteristics of mothers who experienced antepartum and postpartum hemorrhage which was conducted at Efarina Etaham Berastagi Hospital, bleeding data was obtained based on antepartum age 5 35 years 8 people (47.1%), postpartum age 20 years 17 people (68.0%) , 8 people (47.1%) high school antepartum education, 13 high school postpartum education people (52.0), and antepartum family income « Rp. 1200,000 9 people (52.9%), postpartum family income « Rp. 1200,000 13 people (52.0%), Based on the results of the study, 10 people (58.6%) had multiparous antepartum bleeding, 9 people (52.9%) -28 weeks of gestation, 11 people (64.7%) had a history of prenatal bleeding, 15 people had a history of prenatal bleeding. (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital. the cause of placenta previa bleeding was 11 people (64.7%), history of prenatal illness in 15 people (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital. the cause of placenta previa bleeding was 11 people (64.7%), history of prenatal illness in 15 people (88.2%), type of history of pregnancy Sectio (SC) 14 people (82.4%). The results of the research data were 11 people (44%) with multiparous Postpartum Hemorrhage, 9 people (36%) had intervals of delivery »3 years and 2-3 years, 17 people (68%) had retained placenta due to bleeding, 20 people had a history of pre-delivery disease (80 %), type of history of normal pregnancy 22 people (88%). As input material and information in an effort to reduce the morbidity of antepartum bleeding and postpartum bleeding, especially at Efarina Etaham Berastagi Hospital.
Antepartum hemorrhage
Antepartum haemorrhage
Medical record
Vaginal bleeding
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Background: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study is to study the demographic profile, type of antepartum haemorrhage (APH), maternal and perinatal complications and ultimately the maternal and perinatal outcome in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH.
Materials and methods: The present study was a prospective observational study undertaken during a period of 1 year from June 2016 to May 2017 in 54 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age willing to participate in study were included.
Results: The incidence of antepartum hemorrhage was 0.8%.Placenta previa (51.85%) constituted the largest group. Maximum number of patients of APH belonged to the age group 25 to 29 years (40.7%) . In abruption 66.67% and in placenta previa 64.29% of the patients were multiparous. In the undetermined group 57.15% of the patients were multiparous. In abruption, 50% of the patients and in placenta previa 39.28% were in the age group of 31-34 weeks and 6 days. In the present study, 62.95% of the patients were anemic at the time of admission. Majority 57.40% of the anemic patients had Hb of 7.0-9.9 gm.37% patients had Hb more than 10g/dl on presentation. History of previous cesarean section was there in 20.36% of the patients of APH.16.66% patients had preeclampsia as associated risk factor.The commonest mode of delivery was cesarean delivery i.e. 59.2%. In
abruption 33.33% patients delivered by cesarean and 66.66% had normal vaginal delivery . 92.85% of placenta previa had cesarean section which was the largest group. Post partum hemorrhage was the most common complication observed in 9.2% of the cases.Majority (83.33%) of the patients in this study had no major maternal complications.Only 31.39% of the patients required blood transfusions. IUD or still births were noted in 12.96% of the cases.
Neoantal deaths were observed in 3.7%. The largest group (37.03%) of the neonates were found to have low birth weight in the range of 2-2.5 kg.
Prematurity was the most common complication observed in the present study in 50% of the cases. Majority of the premature infants i.e70.37% were from placenta previa group NICU admissions were present in 44.44% of the cases. In the present study, 42.5% of the patients had an APGAR score of <7 at 1 min .
Conclusion
The morbidity and mortality in pregnancies complicated with APH can be achieved by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care centre.
Index Terms:Antepartum hemorrhage,maternal ,perinatal,placenta previa,abruption placenta,post partum hemorrhage.
Placenta previa
Antepartum hemorrhage
Antepartum haemorrhage
Placental abruption
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Summary In a retrospective study of 13656 single births 663 patients had antepartum haemorrhage (4·8 per cent). The incidences of accidental haemorrhage, placenta praevia and “other antepartum haemorrhage” were 2·05, 0·43 and 2·34 per cent respectively. In cases complicated by antepartum haemorrhage there were 66 perinatal deaths; accidental haemorrhage accounted for 65·2 per cent, placenta praevia only 7·6 per cent and “other antepartum haemorrhage” 27·2 per cent. The high perinatal loss in cases of “other antepartum haemorrhage” is particularly associated with prematurity. These findings indicate that patients with painless bleeding in late pregnancy should not be discharged early from hospital simply because the placenta is found to be normally situated. It is suggested that in such patients, rest and observation in hospital should be continued for not less than two weeks after the bleeding has ceased.
Antepartum haemorrhage
Perinatal mortality
Antepartum hemorrhage
Obstructed labour
Accidental
Postpartum haemorrhage
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Summary Twenty‐two patients with antepartum haemorrhage and seven with late threatened abortion were investigated to see whether there was a correlation between the magnitude of feto‐maternal bleeding and the outcome of the pregnancy. It was found that the greater the feto‐maternal transfusion the greater the incidence of placental infarction and of fetal distress in labour. No correlation was found between the amount of revealed antepartum haemorrhage and placental damage.
Antepartum haemorrhage
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Objectives: Antepartum Hemorrhage is bleeding from or into the genital tract from the period of viability of fetus (28 weeks) till the end of second stage of labor. Antepartum hemorrhage is associated with a very high perinatal mortality rate. We present our experience of perinatal outcomes in cases of antepartum hemorrhage with the aim of highlighting the cause of antepartum hemorrhage and the adverse outcomes. Study Design: Descriptive Cross sectional study. Setting: Department of Gynecology & Obstetrics, Sargodha Medical College, Sargodha. Period: Jan 2018 to Jun 2018. Material and Methods: Ninety six pregnant patients between ages of 15-45 years diagnosed as cases of antepartum hemorrhage were enrolled. Patients with coagulation disorders, twin pregnancies, abnormal lie or presentation, previous scar and any known congenital anomaly. Cause of antepartum hemorrhage and mode of delivery was recorded. Perinatal outcomes were determined in terms of frequencies of perinatal mortality, stillbirth and low birthweight babies. Results: The etiology of antepartum hemorrhage in our setup was placenta previa (43.75%); placental abruption (37.5%); Toxemia (10.41%) and unclassified causes in 8.33% patients. The perinatal mortality rate was 43.75% in our study. The overall frequency of low birthweight babies and stillbirth was 62.5% and 27.08% respectively. Conclusion: Antepartum hemorrhage is a major cause of perinatal mortality in our country. A prompt diagnosis of the cause followed by early cesarean section can help reduce the overall mortality.
Antepartum hemorrhage
Placenta previa
Placental abruption
Antepartum haemorrhage
Etiology
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Introduction: Hemorrhage is a life threatening event starting from conception till puerperium and hence obstetrics has been aptly honored to be the business of blood. Antepartum hemorrhage is defined as bleeding per vaginum occurring after the fetus has reached the period of viability but before the birth of baby. Early detection and prompt action can help us provide better maternal care and reduce the morbidity and mortality associated with the same.Materials and Methods: All cases of antepartum haemorrhage ≥ 28 weeks of gestation that were admitted in the hospital over a period of one year were evaluated.Discussion: A total of 133 patients were admitted with antepartum hemorrhage who were then evaluated. Placenta previa was the main cause i.e. 58.5% of APH in the present study. Abruptio placentae and undetermined cases were 23.3% and 18.05% respectively. In our study the most common complications encountered was PPH which had incidence of 41%Conclusion: Awareness of antenatal care during pregnancy, importance of institutional deliveries and adoption of various contraceptive methods (temporary as well as permanent) are the key factors to decrease the morbidity and mortality associated with antepartum hemorrhage and subsequent postpartum hemorrhage.
Antepartum hemorrhage
Placenta previa
Antepartum haemorrhage
Maternal morbidity
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