Management and outcomes of antepartum hemorrhage at Harare maternity hospital

Abstract

Background: Antepartum haemorrhage and its complications are responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide. At Harare Maternity Hospital, the incidence, major causes, burden to the health system, overall contribution to complications is largely unknown. Objectives: To assess the incidence, maternal and perinatal morbidity and mortality as well as to evaluate the management rendered to women presenting with antepartum hemorrhage Study Design: Prospective cross sectional (observational) study carried out on 125 women recruited between August and December 2014. Setting: Harare Maternity Hospital, Zimbabwe. Main Outcome Measures: The study evaluated demographic data, incidence, causes, maternal and neonatal complications and management of antepartum haemorrhage cases. Results: A total of 6033 deliveries were recorded with an incidence of 2.1% for antepartum hemorrhage. The causes included placenta abruption 49(39.2%), placenta previa 44(35.2%), indeterminate 18(14.4%), heavy show 12(9.6%) and ruptured uterus 2(1.6%). Mean age was 29 years (range 17-43) and overall mean parity was 1.6±1.2. Evaluation of management of cases revealed that insertion of large bore cannula, cross matching of blood, catheterisation were achieved in between 70-80% of cases. Maternal complications included postpartum hemorrhage 50(40%), need for transfusion 41(32.8%) and caesarean hysterectomy 4(3.2%). Maternal deaths, 5(4%) were all due to placenta abruption. 44.8% of deliveries were preterm births and 53.6% were admitted to neonatal unit. Stillbirths occurred in 3(6.8%) of placenta previa and 35 (71.4%) of placenta abruption and 3 (9.4%) were due to other causes. Conclusion: The study showed an incidence of anterpartum haemorrhage of 2.1% and a considerable maternal and perinatal morbidity and mortality attributable to antepartum haemorrhage. There were gaps in adhering to the management protocol.