Effects of antepartum hemorrhage on maternal and perinatal adverse outcomes in Northern Ethiopia: a retrospective cohort study.

Abstract

Background: Antepartum hemorrhage (APH) complicates 2-5% of all pregnancies and is the main cause of fetal and maternal death. However, little is known about the adverse maternal and perinatal outcomes of antepartum hemorrhage in the Tigray region. Therefore, this study assessed the effects of antepartum hemorrhage on maternal and perinatal adverse outcomes at Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia, in 2024.

Methods: An institutional-based retrospective cohort study was conducted among 539 mothers who gave birth between September 2019 and August 2021 at Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia. Mothers who gave birth with and without antepartum hemorrhage were categorized as exposed and nonexposed groups, respectively. A systematic sampling method was used to select participants from medical records. Data were collected through a retrospective review of medical records. A modified Poison regression model with robust standard errors was used to estimate relative risk (RR). An adjusted relative risk (ARR) with 95% confidence interval (CI) and a p-value < 0.05 were considered statistically significant.

Results: The incidence of adverse maternal outcomes among mothers with antepartum hemorrhage was 46.1%, compared to 14.2% among mothers without APH. Approximately 57.2% of mothers with APH and 18.9% of those without APH experienced adverse perinatal outcomes. Mothers with antepartum hemorrhage were more likely to experience postpartum hemorrhage (ARR = 3.9, 95% CI: 1.8, 8.8), emergency cesarean section (ARR = 2.9, 95% CI: 2.1, 3.9), preterm birth (ARR = 3.9, 95%CI: 2.8, 5.6), low birth weight baby (ARR = 4.5, 95%CI: 3.0, 6.6), stillbirth (ARR = 3.8, 95%CI: 1.9, 7.4), perinatal death (ARR = 3.7, 95%CI: 2.0, 6.9), admission to the NICU (ARR = 6.7, 95% CI: 3.1, 14.9), low Apgar score at the first minute (ARR = 2.8, 95%CI: 1.8, 4.3), and low Apgar score at the fifth minute (ARR = 3.7, 95% CI: 2.0, 6.8) compared to mothers without APH.

Conclusion: Antepartum hemorrhage is associated with an increased risk of adverse maternal and perinatal outcomes; -including postpartum hemorrhage, emergency cesarean section, preterm birth, low birth weight, stillbirth, perinatal death, a low Apgar score and admission to the NICU. Improving access to emergency obstetric care in areas with a high burden of APH should be critical to ensure timely intervention and reduce adverse maternal and perinatal outcomes.