Introduction
One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away. When labor begins, the cervix starts to open up more or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus [1,2].
Vaginal bleeding after mid-pregnancy is associated with maternal and fetal risks. Maternal morbidity may be caused by acute hemorrhage and operative delivery, and the fetus may be compromised by uteroplacental insufficiency and premature birth. Optimal management of late pregnancy bleeding depends on accurate identification of the cause and a timely intervention specific to its severity [3,4].
Antepartum hemorrhage (A.P.H.) is one of the gravest obstetric emergencies, with dramatic suddenness a pregnant patient can become exsanguinated to the verge of death and her fetus may die. Unlike post-partum hemorrhage, which is always preceded by the adequate warning mechanism of labor, A.P.H. often occurs without warning [4,5].
Antepartum hemorrhage is traditionally defined as any bleeding from the genital tract occurring after 28 wk but before the onset of labor and delivery [6]. Earlier 28 weeks was a legal limit for fetal viability in many countries and it is now sensible to define it as bleeding occurring in 2nd half of pregnancy ≥ 20 weeks.
warning hemorrhage. Maternal mortality form APH has reduced considerably in the last three decades due to improvements in obstetric care and blood transfusion services. Hence the purpose of the study was to study fetal and maternal outcomes in cases of third trimester vaginal bleeding.
Materials and Methods
Study design, study setting, and study duration: The study was conducted in the Institute of Medical Sciences. During this study period, 450 cases had an antepartum hemorrhage. All patients who came with a history of bleeding per vagina after 28 weeks of gestation were hospitalized.
Ethical approval was taken from the institutional ethical committee and written informed consent was taken for the study participants.
Cases with bleeding per vagina after 28 weeks of gestation were included in the study, detailed history and examination of cases, blood investigations, ultrasonography was done and diagnosis of abruption placenta, placenta praevia and other cases who do not fit into these two categories grouped into unclassified and managed accordingly. If patients had come in an emergency without USG, a bedside emergency scan was done to confirm diagnosis and by per vaginal examination or retrospectively after the delivery.
Inclusion Criteria
1) Patient with third trimester bleeding which includes major causes abruption placenta, placenta Previa, unclassified type. 2) Patient from 28weeks of gestation to delivery and discharge from the hospital.
Exclusion criteria
1) Patient with genital lesions who presents with bleeding is excluded. 2) patient less than 28 weeks of gestation Cases > 28 weeks of gestation, with the diagnosis of abruption placenta, placenta praevia and unclassified variety were included in the study, local lesions of vagina and cervix were excluded from the study.
Sixty-four Cases with a history of bleeding per vagina after 28 weeks of gestation were admitted to the hospital. Diagnosis of placenta praevia, abruption placenta, and the unclassified type was made by clinical examination, USG and retrospective diagnosis after delivery by placental examination. Placenta praevia cases- with the live premature fetus, hemodynamically stable, with no or minimal bleeding and not in established labor were managed expectantly with tocolytics, antibiotics, steroids and bed rest.
Depending on the degree of anemia, the correction was done with either blood transfusion or parenteral iron therapy. This expectant management was continued until the term or maturity of fetus and later taken for elective C/S. Patient with a severe bout of bleeding, resuscitation did and emergency C/S was done.
The patient is in established labor, with minimal bleed, good general condition and a minor degree of placenta previa, vaginal delivery was allowed. Abruptio placenta cases - patient not in labor and no maternal, fetal compromise expectant management done if it is preterm, until term with intense fetal and maternal monitoring.
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