Patient charactaristics and outcomes in antepartum haemorrhage due to placenta praevia and abruptio placenta at the University Teaching Hospital, Lusaka, Zambia

Abstract

Background: Placenta praevia and Abruptio placenta are the two major causes of antepartum haemorrhage worldwide including Zambia. They contribute significantly to obstetric haemorrhage, which is a leading cause of maternal mortality in Zambia. Objective: To explore patient characteristics and outcomes in Antepartum haemorrhage due to placenta praevia and abruptio placenta at UTH, Lusaka, Zambia.Study Design: Cross sectional studyMethodology: All women who presented with APH due to placenta praevia and abruptio placenta at UTH in Lusaka, Zambia from October 2013 to January 2014 and met the inclusion criteria were recruited into the study. Participants were interviewed post-delivery after they were clinically stable. Information on patient management was obtained from the patient’s medical records. The maternal outcomes looked at either well or near miss (hypovolaemic shock, DIC and PPH) and fetal outcomes included stillbirths and birth weight.Results: A total of 72 patients with APH were recruited. Of these, 40 (55.6%) cases had placenta praevia and 32 (44.4%) had abruptio placenta. The significant difference in patient characteristic was pregnancy-induced hypertension (OR 36.3, P < 0.001) in those with abruptio placenta compared to placenta praevia. Abruptio placenta was significantly associated with stillbirths (OR 31.7, 95% CI 6.86 to 212.64, P < 0.001). It was also associated with maternal near miss (OR 2.33, 95% CI 0.86 to 6.34, 0.052) although did not reach statistical significance. Delivery by caesarean sections in all those that presented with a fetal heartbeat in abruptio placenta was protective against stillbirth (OR 0.16, 95% CI 0.02 to 1.34 P = 0.09). Conclusion: Despite similarities, some patient characteristics and outcomes in APH due to placenta praevia compared to abruptio placenta differ. Placenta praevia was characterised by previous deliveries by caesarean section whereas placenta abruptio was associated with pregnancy-induced hypertension. Stillbirths were significantly associated with abruptio placenta and severe maternal complications (near miss).