Risk factors of antepartum haemorrhage at Kenyatta National Hospital: a case control study

Abstract

Background Antepartum haemorrhage (APH) is one of the major causes of maternal and perinatal morbidity and mortality. It occurs in 3-5% of pregnancies and is one of the major causes of preterm births. It also contributes to “near miss” cases in both high resource and low resource countries. This study is designed to determine the risk factors of APH. The prompt diagnosis and appropriate management of antepartum haemorrhage would greatly reduce the maternal and perinatal morbidity and mortality associated with obstetric haemorrhage. Objective: To determine the risk factors of antepartum haemorrhage among mothers who receive intrapartum and/or postpartum care at Kenyatta National Hospital. Study design, area and population: This was an unmatched case-control study conducted with permission, at Kenyatta National Hospital (KNH), among women who had delivered at KNH, interviewed in labour ward and postnatal wards. Total sample size was 112, with 56 cases and 56 controls. Materials and Methods: Following informed consent, enrollment of cases and controls who met the eligibility criteria was done by the principal researcher and research assistants. The cases comprised of women at Kenyatta National Hospital labour ward and postnatal rooms, who had been diagnosed with antepartum haemorrhage, interviewed after delivery, while the controls comprised of women admitted at the same time period as the cases, who had delivered vaginally or via caesarean delivery, without antepartum haemorrhage. Data was collected until the desired sample size was met, using a questionnaire filled in with the aid of the interviewer. Data entry was done, and exported to SPSS version 21.0 software for analysis, with results being summarized in form of tables. Results: The mean gestational age (weeks) was 38.9 for the cases and 38.3 for the controls (p< 0.001). Secondary school was the highest level of education attained by the majority, for both the cases (60.7%) and controls (60%). Patients presenting with low abdominal or back pain, were more likely to have antepartum haemorrhage, than those without, OR 38.3 95% CI 4.9-297.2 p< 0.001. The commonest causes of APH were found to be placenta praevia (41.1%) and abruptio placentae (35.7%). A history of abdominal trauma, heavy lifting or fall was reported in 14.3% of cases, while no such history was reported in the control group. Conclusion: This study determined that the only known risk factor found to be significant, was a history of abdominal trauma, heavy lifting or fall, which is commonly associated with abruptio placentae. Abruptio and placenta praevia were found to be the most common causes of antepartum haemorrhage. Recommendations: Early identification of risk factors of APH in pre-conception and antenatal periods, as well as patient education, should be considered as interventions, so as to possibly prevent, and effectively manage antepartum haemorrhage. Further studies on risk factors of antepartum haemorrhage, with larger sample sizes, in the future may be of benefit.