AN 8 YEAR CLINICAL REVIEW OF ANTEPARTUM HAEMORRHAGE AT THE UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL, MAIDUGURI .

Antepartum haemorrhage is an important obstetric emergency and carries increased risk of maternal and perinatal morbidity and mortality. It commonly arises from the placenta as placenta praevia or placental abruption and rarely it may be from a vasa 1 praevia or local lesions in the cervix or vagina . It is crucial to distinguish between these causes from the outset as their definitive management could differ significantly. Early diagnosis is also extremely important to ensure prompt institution of management. With the advent and wide spread use of real time ultrasonography, it is possible for a low lying placenta, the antecedent of placenta praevia, to be detected in the unsuspecting asymptomatic patient so easily that it can be termed one miracle that has 2 attended obstetric practice in the last half centuary . Though the accuracy of ultrasound scan diagnosis of placenta praevia depends on the gestational age, 85% of patients with low lying placenta in early ultrasound scan (12 14 weeks) will become 3,4 normally sited at term . Ultrasound scan has a sensitivity of 49% and specificity of 93 % in predicting placenta praevia most likely to persist at delivery, depending on the degree of placental symmetry with respect to the internal cervical os 5 during the second trimester . Factors associated with increased risk of antepartum haemorrhage include; increased maternal age, high parity, previous caesarean section, threatened abortion, previous uterine 6-12 instrumentation and cigarette smoking . Bleeding of antepartum haemorrhage is characteristically painless in placenta praevia, here the uterus is usually soft with discernable fetal parts and normal fetal heart rate in most cases. However in placental abruption, the uterus is usually woody hard and tender with fetal parts often difficult to palpate. In Background: Antepartum haemorrhage is one of the obstetric emergencies associated with increased maternal and perinatal morbidity and mortality. Objective: To determine the incidence, types, predisposing factors, complications and outcome of antepartum haemorrhage. Methodology: A retrospective study of cases of antepartum haemorrhage over an 8 year period from January 1999 to December 2006 at the University of Maiduguri Teaching Hospital was carried out. Results: The incidence of antepartum haemorrhage was 1.6% (248/15512), while that of placenta praevia and placental abruption were 0.8% and 0.7% respectively. Typically, placenta praevia was detected early in the pregnancy as low lying placenta in 42(36.8%) of cases, while lower abdominal pain, uterine tenderness and woody hard uterus was found in 88(89.8%), 88(85.4%) and 68(69.4%) of cases of placental abruption respectively. The predisposing factors for antepartum haemorrhage were; increasing maternal age, multiparity, previous abortion, previous uterine instrumentation and uterine scar. Threatened abortion in the index pregnancy was associated with placenta praevia while maternal hypertension was associated with placental abruption. The first bleeding episode occurred intrapartum in 74(34.9%) of patients with APH and the majority of them (57 out of 74) had placental abruption. The commonest mode of delivery was caesarean section, which accounted for 135(63.7%) deliveries and 73.3% of these were patients with placenta praevia. Seventy seven women delivered vaginally and 80.5% of them were patients with placental abruption. Preterm labour and post partum haemorrhage were the most common maternal complications while prematurity and increased perinatal mortality were the most common fetal complications. The perinatal mortality was 85(40.1%). There was no maternal mortality from this series. Conclusion: Antepartum haemorrhage is an obstetric emergency associated with increased maternal and perinatal morbidity and mortality unless prompt resuscitative measures and appropriate treatment are offered. Early booking, appropriate referral of high risk patients and routine ultrasound scanning for placental localization are advocated for early diagnosis and optimum maternal and fetal outcomes.